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28/08/2019 6:49 am  

Piracetam In ADHD

Zh Nevrol Psikhiatr Im S S Korsakova. 2004;104(3):32-7.
Therapeutic efficacy of nootropil different doses in attention deficit hyperactivity disorder.

Zavadenko NN, Suvorinova SIu.

Attention Deficit Hyperactivity Disorder (ADHD) is the most common cause of behavioral and learning problems in childhood. Therapeutic efficiency of nootropil (piracetam) in two different doses has been evaluated in the open control study of 80 children with ADHD, 70 boys and 10 girls, aged 6-11 years, being divided into 3 groups. Two groups received nootropil, as a monotherapy, for a month: 1st group (30 patients)--in the dosage of 70 mg/kg daily and 2nd group (30 patients)--40 mg/kg daily orally. The control group of 20 patients did not receive any treatment. All children were examined twice with one month interval. A procedure of assessment included of structured questionnaire to parents, neurological examination with scored evaluation of subtle signs and psychological testing. Nootropil therapy in ADHD children resulted in the improvement of behavioral characteristics, motor coordination as well as continuous, selective and divided attention. A response rate was 60% in patients received 70 mg/kg of nootropil and 43% for nootropil dosage of 40 mg/kg. The results of the study suggest more considerable positive therapeutic effects of nootropil higher dose on behavioral, motor and attention characteristics in children with ADHD.

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28/08/2019 7:17 am  

Piracetam In Age Related Mental Decline

Orv Hetil 2002 May 19;143(20):1129-33
Effects of piracetam on the cognitive functions verified by electrophysiologic methods

Kondakor I. Pecsi Tudomanyegyetem, Neurologiai Klinika, Pecs.

The well-known psychoactive drug widely used in the daily clinical praxis, the piracetam has many therapeutical indications. The drug is extensively applied in the therapy of ischaemic stroke, aphasy as well as of dementias of several origins and age-depending cognitive disturbances. One of the most important effect of piracetam is the positive effect to the cognitive functions. In this publication the author reviews the most important studies, where significant effects of piracetam (chronic or single-dose treatment) were verified by means of electrophysiological methods. These studies proved objectively the positive psychoactive and cognitive effects of the drug, supporting the therapeutical indication of piracetam in such cases, where cognitive deficits are present.

Dement Geriatr Cogn Disord 2002;13(4):217-24
Clinical efficacy of piracetam in cognitive impairment: a meta-analysis.

Waegemans T, Wilsher CR, Danniau A, Ferris SH, Kurz A, Winblad B. Research and Development, UCB SA (Pharma Sector), Braine-l'Alleud, Belgium.

A meta-analysis has been performed including 19 double blind, placebo controlled studies with piracetam in patients suffering from dementia or cognitive impairment in the elderly. These studies had as common outcome measure a clinical global impression of change, a measure of clinically meaningful improvement. The meta-analysis of this global outcome followed the methodology set forward by the Cochrane Collaboration. This article describes the studies, the patient populations and the methods of data extraction. The results of the meta-analysis demonstrate a difference between those individuals treated with piracetam and those given placebo, both as significant odds ratio and as a favourable number needed to treat. While there may be problems in meta-analyses and the interpretation of the statistical results, the results of this analysis provide compelling evidence for the global efficacy of piracetam in a diverse group of older subjects with cognitive impairment.

Presse Med 1997 Sep 6;26(25):1186-91
Combined therapies in family practice and hospitals. A controlled clinical study of a population of 162 patients with criteria of age-related memory disorders

Israel L, Myslinski M, Dubos G, Melac M. Institut de Psychologie, Universite Lumiere Lyon II, Bron.

OBJECTIVES: To assess the combination of drug and cognitive therapy on age-associated memory impairment (AAMI). PATIENTS AND METHODS: A double-blind randomized trial was performed involving 162 patients with age-associated memory impairment selected and followed by their general practitioners. Two intervention methods-a drug and a cognitive therapy-were assessed in combination. Three randomized parallel groups of 54 patients each, aged 55 years and over, were followed and treated for 3 months. After a placebo washout period of 10 days, one group received 2.4 g of piracetam, another group, 4.8 g and the third, a placebo. RESULTS: A total of 135 patients, 45 in each group, completed the study. Combined therapy was most effective in patients whose baseline performance on memory tests was lowest. The best results were observed with piracetam combined with memory training. This result confirmed by the global impression of the principal investigator was in agreement with findings of previous double-blind placebo-controlled trials assessing the combined effect of drug treatment and memory training. CONCLUSION: This result confirmed by the global impression of the principal investigator was in agreement with findings of previous double-blind placebo-controlled trials assessing the combined effect of drug treatment and memory training.

Life Sci 1994;55(25-26):2057-66
Interaction between psychological and pharmacological treatment in cognitive impairment.

Deberdt W. UCB Pharma, Chemin du Foriest, Braine-l'Alleud, Belgium.

In contrast to other kinds of psychotropic drugs, Nootropics or cognition enhancing drugs may be indicated, not for the direct treatment of the pathology itself, but for improving or restoring the remaining brain functions. Brain functions are normally trained during various kinds of non-medical therapy, such as physiotherapy, speech therapy, occupational therapy, memory training etc... In research little attention has been paid to the combination of both kinds of therapeutic approaches, probably because of the important methodological difficulties. This combination however, offers various interesting perspectives: L. ISRAEL examined in two placebo-controlled studies the effects of either 160 mg/d of ginkgo biloba extractum (GBE) or piracetam 2.4 or 4.8 g/d, combined with a memory training program, in nondemented patients complaining of memory problems. The results of both studies suggest that nootropic drug treatment and memory training have each an effect on different cognitive functions and, hence, are complementary. Some functions, like attention/perception in the GBE study and learning in the piracetam study, seem to benefit from both treatments, suggesting a mutually potentiating effect of drug treatment and training. This potentiation is very clear in the treatment of dyslexic children: in a placebo-controlled study piracetam 3.3 g/d, in combination with normal school teaching and more specific logopedic therapy, allowed a normal progression during the full school year in reading accuracy and reading comprehension, while the placebo treated children getting a similar training progressed only with 50%. Recently promising results were obtained in the treatment of dysphasic patients with a combination of speech therapy and piracetam 4.8 g/d, especially when given during the first months after the stroke, or otherwise in combination with an intensive speech training. In both double-blind studies the piracetam treated group improved about 60% more than the group who only got speech therapy and placebo. All these data may be explained by the restorative or enhancing influence of nootropic drugs on neurotransmitter systems closely related to learning and memory functions. E.g. piracetam restores the availability and function of muscarinic and NMDA receptors in aging animals, most probably through a modulation of the psychico-chemical properties of the neuronal membrane such as the membrane fluidity.

Int Psychogeriatr 1994 Fall;6(2):155-70
Drug therapy and memory training programs: a double-blind randomized trial of general practice patients with age-associated memory impairment.

Israel L, Melac M, Milinkevitch D, Dubos G. Grenoble University Hospital, France.

A double-blind randomized trial was performed involving 162 patients with age-associated memory impairment (AAMI) selected and followed by their general practitioners. Two intervention methods--a drug and a cognitive therapy--were assessed in combination. Three randomized parallel groups of 54 patients each, aged 55 years and over, were followed and treated for 3 months. After a placebo wash-out period of 10 days, one group received 2.4 g of piracetam, another group, 4.8g, and the third, a placebo. A total of 135 patients, 45 in each group, completed the study. Combined therapy was most effective in patients whose baseline performance on memory tests was lowest. The best results were observed with 4.8 g of piracetam, especially when training sessions began after 6 weeks of drug treatment. This result was confirmed by the global impression of the principal investigator.

Pharmacopsychiatry 1991 Jul;24(4):121-6
Piracetam in elderly motorists.

Schmidt U, Brendemuhl D, Engels K, Schenk N, Ludemann E. Arbeits- und Forschungsgemeinschaft fur Strassenverkehr und Verkehrssicherheit, University of Cologne, Germany.

101 elderly motorists with reduced reaction capacity were examined under real traffic conditions with regard to their driving ability. They were given a daily dose of 4.8 g piracetam or placebo over a six-week period in a randomised double-blind study. The percentage of correctly solved sign-observance items, which reflects orientation and perception in real traffic conditions, increased in the placebo-treated test-group from 79.86% in the pretest to 80.07% in the retest, whereas the test subjects of the piracetam-treated group improved their performance from 77.08% to 84.16%. After being treated with piracetam for 6 weeks, the drivers showed a significantly better performance than the placebo-group. Of particular interest is the finding that the test-subjects who had scored less than 80% in the pretest improved without exception in the retest after treatment with piracetam.

Acta Neurol (Napoli) 1991 Feb;13(1):1-12
A clinical and neurophysiological trial on nootropic drugs in patients with mental decline.

Gallai V, Mazzotta G, Del Gatto F, Montesi S, Mazzetti A, Dominici P, Della Monica A. Istituto di Clinica Delle Malattie Nervose e Mentali Universita di Perugia, Milano.

The different expressions of mental decline in elderly people, from simple senile benign forgetfulness to SDAT, can be evaluated by psychometric and neurophysiological tests. In the present study, the effects of oxiracetam, Piracetam and placebo were compared in a group of elderly subjects. The results of the trial, structured as single blind, clearly showed that nootropics positively effect both clinical and neurophysiological performances and that oxiracetam produces a more pronounced effect when compared to piracetam. In fact, oxiracetam was found more effective in improving psychometric scales such as GDS (clinical performances) as well as the amplitude and the latency of the P300 (neurophysiological performances), which reflect a functional recovery of the cerebral pathways related to attention and memory.

Arch Gerontol Geriatr. 1985 Jul;4(2):141-55.
Haemorheological pattern in initial mental deterioration: results of a long-term study using piracetam and pentoxifylline.

Parnetti L, Ciuffetti G, Mercuri M, Senin U.

A group of 80 elderly subjects affected with recent onset (less than 6 mth) slight to moderate mental deterioration was observed before and after oral drug treatment for a period of 28 wk. The study consisted of four randomized groups of subjects homogeneous for age, sex and life habits. The first group received a placebo, the second group received piracetam (1600 mg 3 times a day), the third group received pentoxifylline (400 mg 3 times a day), and the fourth group received a combination of piracetam and pentoxifylline. At the beginning and end of each phase of the study, neuropsychological and haemorheological parameters were evaluated in all subjects. The results show that the most evident improvement in psycho-intellectual performance, associated with an increase of whole blood filtration values, was obtained in the group treated with the two-drug combination.

Acta Psychiatr Belg 1983 Jul-Aug;83(4):349-58
Nootropic drugs and aging.

Giurgea CE, Greindl MG, Preat S.

Nootropics are drugs, which ameliorate the functional "plasticity" of the central nervous system. The nootropic drug acts at the telencephalic level through a series of bioenergetic, hemorheological, microcirculatory and neurochemical mechanisms.

Psychopharmacology (Berl). 1983;81(2):100-6.
Piracetam in elderly psychiatric patients with mild diffuse cerebral impairment.

Chouinard G, Annable L, Ross-Chouinard A, Olivier M, Fontaine F.

In a 12-week double-blind study, piracetam at two dose levels (2.4 and 4.8 g/day) was compared to placebo in the treatment of 60 elderly psychiatric patients with mild diffuse cerebral impairment, but no signs of focal brain lesion. The psychiatric illness, schizophrenia or affective disorder, of patients selected was in remission at the time of the study. Monthly evaluations by the nurse revealed that piracetam improved overall functioning, particularly alertness, socialization, and cooperation, relative to the control group. Patients treated with 2.4 g/day piracetam also showed significant improvement in scores for the full IQ and the memory quotient on the Wechsler Adult Intelligence and Memory Scales; greater response was seen in those with lower initial scores. Piracetam at 4.8 g/day had a more rapid onset of action on behavioral variables than 2.4 g/day, but its therapeutic effect tended to diminish at 12 weeks, possibly as the result of overstimulation. Piracetam did not appear to interfere with concomitant psychotropic maintenance medication or affect the psychiatric illness itself.

Arzneimittelforschung 1978;28(9):1529-30
Piracetam and vigilance. A study of EEG changes and clinical effects in gerontopsychiatric patients (author's transl)

Bente D, Glatthaar G, Ulrich G, Lewinsky M.

The electroencephalographic and clinical effects of piracetam were studied in a group of 11 hospitalized gerontopsychiatric patients treated with a daily dosage of 4.8 g for 8--13 months. The EEG was evaluated by power spectral analysis, followed by a principal component analysis of frequency parameters. The statistical analysis of the resulting factor scores shows that piracetam induces significant EEG changes: decrease of slow frequencies, augmentation and acceleration of alpha-activity and increase of beta-activity. These EEG changes, indicating an increase in vigilance, correspond clinically to an improvement of communicative behavior and cognitive functioning.

Acta Psychiatr Scand 1976 Aug;54(2):150-60
Piracetam-induced improvement of mental performance. A controlled study on normally aging individuals.

Mindus P, Cronholm B, Levander SE, Schalling D.

A double-blind, intra-individual cross-over comparison of the mental performance of 18 aging, non-deteriorated individuals during two 4-week periods of piracetam (1-acetamide-2-pyrrolidone) and placebo administration was performed using conventional and computerized perceptual-motor tasks. In a majority of these tasks the subjects did significantly better when on piracetam than on placebo, a finding consistent with ratings completed by two independent observers. The findings indicate new avenues for the treatment of individuals with reduced mental performance possibly related to disturbed alertness--a neglected group of psychiatric conditions.

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28/08/2019 7:41 am  

Piracetam In Alzheimer's Disease & Dementia

J Int Med Res 2001 Jan-Feb;29(1):28-36
Efficacy of acetylcholinesterase inhibitors versus nootropics in Alzheimer's disease: a retrospective, longitudinal study.

Tsolaki M, Pantazi T, Kazis A. Third Department of Neurology, Aristotle University of Thessaloniki, Greece.

The aim of this study was to investigate the efficacy of nootropics (piracetam, aniracetam, nimodopine and dihydroergicristine) versus acetylcholinesterase inhibitors (AChE-Is) (tacrine and donepezil) in the treatment of Alzheimer's disease. This is a retrospective study of 510 patients with Alzheimer's disease. To determine clinical efficacy of treatment, we used the mean change over time in scores for the following tests: the Mini-Mental State Examination (MMSE); the Cambridge Cognitive Examination for the Elderly; and the Functional Rating Scale for Symptoms of Dementia. In all patients and in patients with severe Alzheimer's disease (baseline MMSE < 11), no significant differences were seen in the neuropsychological test scores between the two treatment groups. In patients with moderate dementia (baseline MMSE between 11 and 20), however, there was a significantly greater deterioration, as shown on the CAMCOG scale, after 12 months' treatment for patients receiving AChE-Is compared with those receiving nootropics (-4.38 for AChE-Is group versus 1.48 for nootropics group). For patients with mild dementia (baseline MMSE score between 21 and 26), there was a significantly greater deterioration on the MMSE scale for each time-point in the nootropics group compared with the AChE-Is group. In conclusion, we did not find any strong evidence that a difference in efficacy exists between AChE-Is and nootropics in the treatment of Alzheimer's disease.

Acta Neurol Scand Suppl 2000;176:12-9
A pharmacogenomic approach to Alzheimer's disease.

Cacabelos R, Alvarez A, Fenandez-Novoa L, Lombardi VR. EuroEspes Biomedical Research Center, Institute for CNS Disorders, La Coruna, Spain.

Single nucleotide polymorphisms (susceptibility genetics) and genomic point mutations (mendelian genetics) can be used in Alzheimer's disease (AD) for diagnostic, predictive and therapeutic purposes. Using a matrix genetic model, including APOE, PS1 and PS2 allelic variants, we have studied the distribution of 36 different genotypes in the AD population (N= 479) and the genotype-related cognitive response to a multifactorial therapy in AD patients with mild-to-moderate dementia. The 10 most frequent AD genotypes are the following: 1) E33P112P2 + (17.75%), 2) E33P112P2- (15.55%), 3) E33P111P2+ (10.85%), 4) E34P112P2+ (9.60%), 5) E34P112P2- (7.56%), 6) E33P111P2- (7.10%), 7) E34P111P2+ (4.80%), 8) E33P122P2+ (4.38%), 9) E34P111P2- (4.18%), and 10) E34P122P2+ (3.55%). APOE-4/4-related genotypes represent less than 3% in the following order: E44P112P2 + > E44P111P2+ = E44P111P2- > E44P112P2+ > E44P122P2+ = E44P122P2. Multifactorial therapy with CDP-choline (1,000 mg/day) + piracetam (2,400 mg/day) + anapsos (360 mg/day) did improve mental performance during the first 6-15 months in a genotype-specific fashion. The best responders in the APOE series were patients with APOE-3/4 genotype (r= +0.013), while the worst responders were APOE-4/4 patients (r= -0.93). PS1-related genotypes responded in a similar manner; and patients with a defective PS2 gene exon 5 (PS2+) always showed a poorer therapeutic response than PS2- patients. All these data suggest that the therapeutic outcome in AD exhibits a genotype-specific pattern, and that a pharmacogenomic approach to AD might be a valuable strategy for drug development and monitoring.

J Neural Transm 1999;106(7-8):757-61
Piracetam reverses hippocampal membrane alterations in Alzheimer's disease.

Eckert GP, Cairns NJ, Muller WE. Department of Pharmacology, Biocenter, University of Frankfurt, Federal Republic of Germany.

The in vitro effects of piracetam treatment on the fluidity of membranes from the hippocampus of Alzheimer's Disease patients (AD) and non-demented controls were studied. Hippocampal membranes of AD patients showed a significant lower hydrocarbon core fluidity compared with membranes from elderly non-demented controls. Preincubation with piracetam enhanced the hydrocarbon core fluidity of hippocampal membranes from AD-patients as well as elderly controls in a concentration depending fashion, although the effect was more pronounced for the AD membranes. In the presence of piracetam, the difference of the membrane fluidity between AD and control membranes was not longer apparent.

Neurodegeneration 1995 Dec;4(4):349-56
The pharmacotherapy of Alzheimer's disease based on the cholinergic hypothesis: an update.

Weinstock M. Department of Pharmacology, Hebrew University Hadassah Medical Centre, Jerusalem, Israel.

Alzheimer's disease (AD) is a neurodegenerative disorder with impairment of cognitive function and personality. The synaptic loss, neuronal atrophy and degeneration of cholinergic nuclei in the basal forebrain may be associated with a reduction in oxidative metabolism of glucose, a fall in acetyl CoA and ATP. Current pharmacological strategies, aimed at increasing cholinergic activity include acetylcholinesterase (AChE) inhibitors, cholinergic agonists, acetylcholine (ACh) releasers and stimulants of nerve growth factors (NGF). AChE inhibitors, physostigmine and Tacrine can slow the decline of cognitive function and memory in some patients with mild or moderate AD, if given for at least 3-6 months in sufficient doses to inhibit brain AChE. Their main disadvantages are low oral bioavailability, peripheral cholinergic hyperactivity and liver toxicity with Tacrine. Newer, less toxic AChE inhibitors, with selective central activity, formulations of physostigmine, selective Ml and nicotinic agonists are becoming available with improved bioavailability and pharmacokinetics. These may increase the likelihood of therapeutic benefit in AD. Nootropic drugs, e.g. Piracetam, which release ACh and are relatively non-toxic could possibly slow the progression of the disease. A combination of an AChE inhibitor, piracetam and a stimulator of NGF may show additive effects on memory processes but with a lower incidence of untoward effects.

Funct Neurol 1993 Sep-Oct;8(5):335-45
Auditory and visual event-related potentials in patients suffering from Alzheimer's dementia and multiinfarct dementia, before and after treatment with piracetam.

Dabic-Jeftic M, Mikula I. University Department for Neurology, Psychiatry, Alcoholism and other Addictions, University Hospital Sestre Milosrdnice, Zagreb, Croatia.

We have done a study on 7 subjects suffering from Alzheimer's dementia (AD) and 15 subjects suffering from multiinfarct dementia (MID) to see whether they manifest any changes of amplitudes or latencies concerning event-related potentials (ERP) compared to a group of normal controls and how three months of treatment with piracetam affects those changes. We found that the latencies of all waves are longer in the groups of subjects suffering from AD and MID compared to the normal controls, except for the N100 wave, which showed shorter latency in the AD group. Amplitudes were lower in the groups of patients suffering from AD and MID. These changes were most prominent for the P300 wave. Treatment with piracetam reduced those changes in the precognitive part, though it seemed to have no effect on the cognitive part.

Neurology 1993 Feb;43(2):301-5
Long-term and high-dose piracetam treatment of Alzheimer's disease

Croisile B, Trillet M, Fondarai J, Laurent B, Mauguiere F, Billardon M. Department of Neurology, Hopital Neurologique, Lyon, France.

Preclinical research suggests that piracetam (a nootropic drug) may improve cognitive functions, but previous studies have failed to demonstrate a clear benefit for the treatment of Alzheimer's disease (AD). We report a 1-year, double-blind, placebo-controlled, parallel-group study with a high dose of piracetam (8 g/d per os) in 33 ambulant patients with early probable AD. Thirty subjects completed the 1-year study. No improvement occurred in either group, but our results support the hypothesis that long-term administration of high doses of piracetam might slow the progression of cognitive deterioration in patients with AD. The most significant differences concerned the recall of pictures series and recent incident and remote memory. The drug was well-tolerated.

Int Psychogeriatr 1992 Summer;4(1):25-44
Moving from the question of efficacy to the question of therapeutic relevance: an exploratory reanalysis of a controlled clinical study of 130 inpatients with dementia syndrome taking piracetam.

Herrmann WM, Stephan K. Psychiatrische Klinik und Poliklinik, Freien Universitat-Berlin, Germany.

The authors reanalyzed previously published data from a prospectively randomized, placebo-controlled, double-blind phase-III study of 130 inpatients with dementia syndrome. The patients in the study had been diagnosed as having suffered from organic brain syndrome (ICD 290), which is the core syndrome of dementia (so-called dementia syndrome) for at least two years. They were treated with piracetam for three months at a dose level of 4,800 mg/d. These data were reexamined in order both to survey the extent of drug-related improvement and response rates when assessed at different levels and to investigate the comparability of efficacy in subgroups suffering from either senile dementia of the Alzheimer type or multi-infarct dementia. Three scales were used for the assessment of efficacy. They were the CGI, or Clinical Global Impression, completed by the physicians; the SCAG, or Sandoz Clinical Assessment Geriatric, used by clinical psychologists; and the BGP, or Beurteilungsskala fur Geriatrische Patienten (Evaluation Scale for Geriatric Patients), employed by the nursing staff. The Syndrome-Kurztest (SKT) and Benton tests served to measure performance. The items and subscores of the SCAG and the SKT were highly intercorrelated at baseline, forming a common factor fairly independent of the information gained by BGP. This suggests that merely using different kinds of information-gathering methods, i.e., clinical scales and performance tests, completed by different groups of observers, does not automatically result in nonredundant comprehensive information. When using the most conservative response criterion of individual improvement, i.e., at least one baseline standard deviation, treatment with piracetam showed statistically significant (pe less than .001) explorative response rates of 50% and above in three out of four target variables, as compared to the 0 to 6% obtained with placebo. CGI was used as descriptive variable. Again, using this response criterion from a separate analysis of diagnostic subgroups, as matched by the median of the patients' Hachinski Ischemic Scale scores, it does not appear that piracetam's efficacy for patients with senile dementia of the Alzheimer type (SDAT) varies with its efficacy for patients with multi-infarct dementia (MID).

Neurophysiol Clin 1991 Dec;21(5-6):411-23
The significance of quantified EEG in Alzheimer's disease. Changes induced by piracetam

Pierlovisi-Lavaivre M, Michel B, Sebban C, Tesolin B, Chave B, Sambuc R, Melac M, Gastaut JL, Poitrenaud J, Millet Y. Laboratoire d'explorations fonctionnelles du systeme nerveux, CHU Timone, Marseille, France.

One study was performed in 12 patients with presenile Alzheimer's disease (group I), the other one in 16 patients with mild senile dementia of Alzheimer type (group II). In each study, patients were divided into two randomized parallel groups, one receiving placebo, the other piracetam (9 g daily in group I piracetam and 2.4 g daily in group II piracetam) during three months, piracetam induced a decrease in EEG power on the 2-6 Hz range (group I piracetam), 3-5 Hz and 7 Hz (group II piracetam) and an increase of EEG power in the 9-11 Hz range (group I piracetam) and in the 10 Hz and 13 Hz frequencies (group II piracetam). There was also a significant improvement in the Trail Making Test part A in group II piracetam. Correlations between decreased EEG low frequency components and improvement in some psychometric tests were found significant in the two groups. It seems that the main effect of piracetam was to induce increased alertness. The same results were found in both studies; the good reproducibility suggests that EEG spectral analysis is a reliable tool in the assessment of psychotropic drug effects.

J Cereb Blood Flow Metab 1988 Aug;8(4):613-7
Effect of piracetam on cerebral glucose metabolism in Alzheimer's disease as measured by positron emission tomography.

Heiss WD, Hebold I, Klinkhammer P, Ziffling P, Szelies B, Pawlik G, Herholz K. Max-Planck-Institut fur neurologische Forschung, Cologne, F.R.G.

The effect of piracetam (a putative enhancer of cerebral metabolism) on regional CMRGlu was studied by positron emission tomography of 2[18F]-fluoro-2-deoxy-D-glucose in nine patients with Alzheimer's disease, and in seven cases with multiinfarct dementia or unclassified dementia. In Alzheimer's disease, i.v. administration of piracetam, 6 g b.i.d. for 2 weeks, significantly improved rCMRGlu in most cortical areas, whereas no effect on CMRGlu of the drug was observed in the multiinfarct dementia/unclassified dementia groups. These results lend further support to the notion that adjuvant piracetam treatment is of benefit in Alzheimer's disease. They may also indicate that the typical metabolic depression in Alzheimer's disease is caused by complex interaction of disturbed transmitter and cellular function rather than by a specific deficit in the cholinergic system alone.

Acta Psychiatr Belg 1980 Sep-Oct;80(5):748-54
Acute effect of drugs upon memory of patients with senile dementia.

Delwaide PJ, Devoitille JM, Ylieff M.

Memory has been tested in senile demented patients with the Rey Auditory Verbal Learning Test. The processus of memorization can be significantly facilitated in acute conditions by lysin-vasopressin, to a lesser degree by piracetam and highly worsened by scopolamine. No effect of physostigmine has been observed.

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28/08/2019 7:58 am  

Piracetam In Cardiovascular Disorders

Klin Med (Mosk) 1997;75(1):32-5
Piracetam and tocopherol acetate [Vitamin E] ability to potentiate clinical effect of antianginal drugs in presenile and senile patients with ischemic heart disease (unstable angina)

Pimenov LT, Churshin AD, Ezhov AV. Department of Polyclinic Therapy, State Medical Academy, Izhevsk.

Potentiating ability of piracetam and tocopherol acetate was studied outpatiently in aged patients with ischemic heart disease. It was found that the addition of piracetam and tocopherol acetate to conventional antianginal drug therapy brings higher response and exercise tolerance, contributes to more effective hemodynamic and energetic support of the exercise, to positive changes in the central and peripheral hemodynamics.

Tr Prom Ekol 1995;(10):26-8
Effects of piracetam on occupationally significant functions of patients with arterial hypertension working under conditions of psychoemotional stress.

Dasaeva LA.

The study covered influence of Piracetam on occupationally important functions of memory and attention in hypertensive patients exposed to psychoemotional stress at work. The medicine appeared to improve psychic state, mental performance and the occupationally important function of memory, causing no effects on the attention. Besides hypotensive effect the medicine resulted in better clinical and physiologic parameters and increased physical performance.

Kardiologiia 1992 May;32(5):35-7
Clinical and hemodynamic effect of piracetam (Nootropil) in elderly and very old patients with coronary heart disease in the outpatient rehabilitative period.

Pimenov LT, Kalinina SA, Churshin AD.

The clinical and hemodynamic efficiency of piracetam (nootporil) used in the long-term combined therapy of elderly and senile patients with chronic coronary heart diseases was studied outpatiently. This drug led to a significant enhancement of the antianginal effect of the basic treatment, to more regression of clinical signs of chronic circulatory insufficiency, to positive central hemodynamic changes, higher exercise tolerance, lower energy consumption index per performance unit, increased adaptive potential of the circulatory system, and maintained optimal cerebral blood flow.

Klin Med (Mosk) 1989 May;67(5):36-8
Experience using nootropil [Piracetam] in patients with chronic ischemic heart disease.

Shubina TI, Zaitsev VP.

Course nootropil treatment was conducted in 34 IHD patients with neurotic and neurotic-like diseases. Dynamic changes in the psychic state were assessed by the clinical scale and the MMPI psychological test. Significant improvement or normalization of the psychic state was achieved in 58.8% of the patients treated with nootropil. The best results were obtained in the treatment of asthenic states. Administration of nootropil had no influence on the incidence of angina pectoris attacks and produced no side effects.

Kardiologiia 1987 Feb;27(2):46-50
Therapeutic use of piracetam in myocardial infarct patients

Leshchinskii LA, Pimenov LT, Fedorov VS.

54 patients with acute myocardial infarction were evaluated repeatedly, with 28 of those treated with piracetam, and 26 used as controls. Piracetam produced a considerable favorable effect on the clinical course of myocardial infarction, as reflected in a more rapid clinical improvement of acute circulatory insufficiency and an analgetic effect. The drug reduced heart rate and moderately elevated systolic arterial blood pressure. Positive changes in total CPK, LDH, AST and ALT activities, and in ECG from 12 and 35 leads were quicker to come.

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28/08/2019 8:16 am  

Piracetam In Cerebral Palsy

S Afr Med J 1978 Jun 3;53(22):889-91
Piracetam in the management of spasticity in cerebral palsy.

Maritz NG, Muller FO, Pompe van Meerdervoort HF.

This article is a preliminary report of a new indication for the drug piracetam (Nootropil; UCB). It was found that piracetam was useful for the control of spasticity in 8 out of 16 patients with cerebral palsy. Side-effects were minimal.

Arq Neuropsiquiatr 1976 Jun;34(2):167-72
Pyrrolidine acetamide as an auxiliary drug in the treatment of cerebral palsy

Chagas Ribeiro FS, Silva P, Boas Doria ML, de Oliveira Lima A, Prates Campos M, Novaes Ferreira A, Rocha Santos MJ, Avila RL, da Silva Martins I.

20 children, with the diagnosis of cerebral palsy (CP) and under classical, physiotherapeutical and pedagogical, treatment, received piracetam (pyrrolidine acetamide) as an auxiliary drug. The goal was to better spasticity, learning and nervous instability problems aiming at better results of over-all treatment of CP. The group that received the drug has been compared to a control group of 20 children treated by the customary treatment only. The comparison showed favourable results for the medicated group. The drug was administered in the dose of 80 mg/kg/day during 10 weeks. The criteria for evaluation have been psychological, clinical, physiotherapeutical and pedagogical. The drug has been given in a new form of presentation: 6% solution for oral use.

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28/08/2019 8:41 am  

Piracetam In CerebralVascular Disorders

Neurol Neurochir Pol 1981 Jul-Aug;15(4):447-51
Comparative evaluation of psychoactive drugs used in patients with subacute and chronic cerebrovascular disorders

Wasilewski R, Lebiediewa N, Kozlowa E, Wolkow W.

The report is based on 315 patients with subacute and chronic cerebral circulatory disturbances caused mostly by atherosclerosis aged 30 to 82 years, treated for 1-6 months. In 90 cases Piracetam (Nootropil) was given, 107 received Piritinol (Encephabol, Enerbol), 77 Piriditol, 41 Centrophenoxin. The patients were allocated randomly to these groups. In the treated patients improvement was achieved in a considerable proportion of cases (44-82%) treated with different drugs. This improvement manifested itself as regression or decreased intensity of neurotic complaints, labyrinthine-cerebellar signs, pyramidal signs, anxiety and fears, improvement of recent memory, attention, psychomotor activity. The best results were obtained with Nootropil, moderately good with Centrophenoxin, Encephabol, and poor with Piriditol. Drug tolerance was best with Encephabol, while that of other drugs was slightly worse. The only disquieting symptoms were activation of epileptic seizures in several patients treated with Nootropil or Centrophenoxin. The best way of administration was giving the drugs in two doses in the morning hours and at noon. The authors regard as useful the treatment of patients with subacute and chronic cerebral circulatory failure with psychoenergizing drugs.

Neurol Neurochir Pol 1980;14(2):177-82
Effectiveness of parenteral administration of piracetam in acute and chronic consciousness disorders in cerebral arteriosclerosis

Sobczyk W.

The effectiveness of treatment with piracetam of 32 patients with acute and chronic consciousness disturbances caused by clinical syndromes of cerebrovascular disease (strokes, syndromes of dementia) was studied. The drug was administered in drip infusions in daily doses of 6 g for 10 days. A statistically significant improvement was obtained in the signs belonging to the syndrome of consciousness disturbances. No significant difference was observed in the power of action of the drug in acute and chronic consciousness disturbances.

Zh Nevropatol Psikhiatr Im S S Korsakova 1989;89(12):19-23
Significance of subjective symptoms and diagnostic criteria in initial forms of cerebral circulation insufficiency

Eninia GI, Purinia IV, Robule VKh, Maiore IKh, Timofeeva TN, Berzina AIa.

Piracetam was applied to the treatment of 60 patients with initial manifestations of brain circulation failure and stage I circulatory encephalopathy. The drug exerted a beneficial therapeutic effect by reducing high brain vascular resistance (both extra- and intracranial) and by increasing the lowered volume of pulse fluctuations. It made fibrinolytic blood activity and aggregation of formed elements of the blood return to normal. An appreciable antiatherogenic effect was discovered as well. It should be taken into consideration that in patients with a dramatic lowering of pulse fluctuations, the use of piracetam in a dose of 1.6 g/day may enhance headache. In such cases the dose should be reduced.

Psychopharmacology (Berl) 1983;81(2):100-6
Piracetam in elderly psychiatric patients with mild diffuse cerebral impairment.

Chouinard G, Annable L, Ross-Chouinard A, Olivier M, Fontaine F.

In a 12-week double-blind study, piracetam at two dose levels (2.4 and 4.8 g/day) was compared to placebo in the treatment of 60 elderly psychiatric patients with mild diffuse cerebral impairment, but no signs of focal brain lesion. The psychiatric illness, schizophrenia or affective disorder, of patients selected was in remission at the time of the study. Monthly evaluations by the nurse revealed that piracetam improved overall functioning, particularly alertness, socialization, and cooperation, relative to the control group. Patients treated with 2.4 g/day piracetam also showed significant improvement in scores for the full IQ and the memory quotient on the Wechsler Adult Intelligence and Memory Scales; greater response was seen in those with lower initial scores. Piracetam at 4.8 g/day had a more rapid onset of action on behavioral variables than 2.4 g/day, but its therapeutic effect tended to diminish at 12 weeks, possibly as the result of overstimulation. Piracetam did not appear to interfere with concomitant psychotropic maintenance medication or affect the psychiatric illness itself.

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28/08/2019 9:05 am  

Piracetam In Dyslexia

J Clin Psychopharmacol 1987 Aug;7(4):230-7
Piracetam and dyslexia: effects on reading tests.

Wilsher CR, Bennett D, Chase CH, Conners CK, DiIanni M, Feagans L, Hanvik LJ, Helfgott E, Koplewicz H, Overby P, et al.

Previous research has suggested that dyslexics treated with piracetam have shown improvements in reading skills, verbal memory and verbal conceptualizing ability, feature analysis, and processing of letter-like stimuli. Two hundred twenty-five dyslexic children between the ages of 7 years 6 months and 12 years 11 months whose reading skills were significantly below their intellectual capacity were enrolled in a multicenter, 36-week, double-blind, placebo-controlled study. Children of below average intelligence, with abnormal findings on audiologic, ophthalmologic, neurologic, psychiatric, and physical examinations, who were emotionally disturbed or educationally deprived and who had recently been treated with psychoactive medication were excluded from the trial. Piracetam was well tolerated, with no serious adverse clinical or laboratory effects reported. Piracetam-treated children showed significant improvements in reading ability (Gray Oral Reading Test) and reading comprehension (Gilmore Oral Reading Test). Treatment effects were evident after 12 weeks and were sustained for the total period (36 weeks).

Int J Psychophysiol 1986 May;4(1):53-61
The effect of piracetam on short- and long-term verbal retrieval in dyslexic boys.

Helfgott E, Rudel RG, Kairam R.

Studies of 60 dyslexic boys age 8-14, carefully selected for exclusion of intellectual, sensory, psychiatric and neurological impairment and educational deprivation, were conducted to determine the efficacy of Piracetam, over a 12-week period, in improving reading and other related skills. There were no changes at the end of 12 weeks to distinguish the groups in accuracy or comprehension of prose-reading. Short-term memory gains, however, were recorded for the treated group on two different tests, digit span, and a test (Neimark) of immediate and delayed recall. The mean digit span scaled score for the entire group was one S.D. below their mean IQ. Considering only the performance of children whose digit span scaled scores were one S.D. or below the mean (7 or less), the treated group made a significant gain at the end of 12 weeks. On the Neimark test the treated group was significantly superior to the untreated group on first trial learning and they also lost significantly fewer object names after a delay. Improved retrieval from long-term storage could be demonstrated for the treated group on the rapid automatized naming test. Although there was no significant difference between the group at screening, the treated group was significantly faster on letter naming at the end of the drug trial. The treated group also improved their single word reading on the WRAT.

Int J Psychophysiol 1986 May;4(1):41-52
Evaluation of the efficacy of piracetam in treating information processing, reading and writing disorders in dyslexic children.

Tallal P, Chase C, Russell G, Schmitt RL.

Piracetam, a new class of drug (nootropil) thought to enhance specific cognitive skills, was given in a 3300 mg daily dose to half of a group of fifty-five dyslexic boys aged 8-13 years, in a 12-week, double-blind, placebo-controlled study. The other half of the subjects received placebo. All subjects met the following criteria: normal intelligence, normal educational opportunities, no severe emotional problems, no neurological handicaps, good physical health, not taking other psychotropic medication, and scoring at least one and one half years below their mental age equivalent on the Gilmore Oral Reading Test. Non-verbal (auditory and visual) and verbal perceptual, and memory skills were examined, and reading, spelling, language and writing abilities were measured using standardized instruments. Compared to the placebo control group, individuals treated with Piracetam did not show statistically significant improvements above their baseline scores on measures of perception, memory, language, reading accuracy or comprehension, or writing accuracy. However, reading speed and numbers of words written in a timed period were significantly enhanced in subjects treated with Piracetam as compared to placebo. Effective reading and writing ability, taking both rate and accuracy into consideration, were also significantly improved in the Piracetam as compared to the placebo treatment group. The medication was well-tolerated and medical examinations showed no significant adverse reactions. These results encourage further study of Piracetam to determine more precisely the mechanism of action by which specific cognitive skills are affected.

J Clin Psychopharmacol 1985 Oct;5(5):272-8
The effects of piracetam in children with dyslexia.

Di Ianni M, Wilsher CR, Blank MS, Conners CK, Chase CH, Funkenstein HH, Helfgott E, Holmes JM, Lougee L, Maletta GJ, et al.

Following previous research which suggests that piracetam improves performance on tasks associated with the left hemisphere, a 12-week, double-blind, placebo-controlled study of developmental dyslexics was conducted. Six study sites treated 257 dyslexic boys between the ages of 8 and 13 years who were significantly below their potential in reading performance. Children were of at least normal intelligence, had normal findings on audiologic, ophthalmologic, neurologic, and physical examination, and were neither educationally deprived nor emotionally disturbed. Piracetam was found to be well tolerated in this study population. Children treated with piracetam showed improvements in reading speed. No other effects on reading were observed. In addition, improvement in auditory sequential short-term memory was observed in those piracetam-treated patients who showed relatively poor memory at baseline. It is suggested that longer term treatment with piracetam may result in additional improvements.

Psychopharmacology (Berl) 1979 Sep;65(1):107-9
Piracetam as an aid to learning in dyslexia. Preliminary report.

Wilsher C, Atkins G, Manfield P.

Sixteen male dyslexic children were seen again when adults and matched with 14 student volunteers for a 21-day trial of piracetam. It was found, using a double-blind cross-over technique, that dyslexics significantly increased their verbal learning by 15.0% and students by 8.6% (over and above their placebo increase).

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28/08/2019 9:26 am  

Piracetam In Head Trauma

Eksp Klin Farmakol. 2003 Jul-Aug;66(4):6-8.
Effect of Piracetam on the color discriminative function of retina in patients with craniocerebral trauma.
Ovanesov KB, Shikina IB, Arushanian EB, Shchurovskaia IIu. Department of Pharmacology, State Medical Academy, ul. Mira 310, Stavropol, 355024 Russia.

The chronic administration of piracetam over a period of four weeks in patients after heavy craniocerebral traumas significantly improves the color discrimination of retina with respect to all four colors studied. It is suggested that the improved functioning is related to the nootrope effect upon the GABAergic processes both in the retina and in the related cerebral structures.

Neurol Neurochir Pol 1998 Sep-Oct;32(5):1189-97
Piracetam in severe cranio-cerebral injuries

Goscinski I, Sliwonik S, Sondej T, Kwiatkowski S, Moskala M, Cichonski J, Wegrzyn D, Uhl H. Kliniki Neurotraumatologii Instytutu Neurologii Collegium Medicum UJ.

A group of 100 patients treated immediately following a cranio-cerebral injury was analyzed. The patients, administered piracetam either in an intravenous infusion (GCS 3-8) or orally (GCS above 9), were divided into groups depending on the dose and clinical status. Piracetam participates in the activity of the majority of neurotransmitters, increases glucose and oxygen consumption in the ischaemic nervous tissue and increases blood flow through cerebral terminal vessels. In cranio-cerebral injuries, piracetam is employed to achieve cytoprotection and improve cerebral blood flow. In patients with neurological deterioration following the administration of 6-10 mg/day, no good results were obtained. A dose of 24-30 mg/day had a significant positive effect on therapeutic results providing certain conditions were met, such as ensuring proper partial oxygen pressure (oxygen therapy) and proper blood glucose levels. The use of piracetam is justified immediately after an injury; after the discharge oral piracetam therapy is recommended.

Przegl Lek 1999;56(2):119-20
Clinical observations concerning piracetam treatment of patients after craniocerebral injury

Goscinski I, Moskala M, Cichonski J, Polak J, Krupa M, Sliwonik S, Sondej T. Kliniki Neurotraumatologii Instytutu Neurologii Collegium Medicum Uniwersytetu Jagiellonskiego w Krakowie.

Piracetam (Nootropil) is a cytoprotective to brain tissue and improving cerebral blood flow medicine. In the Department of Neurotraumatology we investigated results of piracetam treatment in a group of 100 succeeding patients admitted between 1995-96 due to craniocerebral injury. High doses (24-30 g per day) of this medicine have a positive effect on final result of treatment, when treatment is initiated immediately after the injury and described conditions are abided. We also showed usefulness of piracetam treatment in posthospital management.

Zh Nevropatol Psikhiatr Im S S Korsakova 1988;88(5):42-8
Effect of piracetam on the functional activity of the brain in patients with craniocerebral injuries

Sharova EV, Potapov AA, Kulikov MA.

Repetitive EEG spectral analysis in 32 patients after severe of mild head trauma revealed two types of responses to Piracetam evidencing the ambiguity of its effect on unspecific activating brain structures. Besides the brain cortex, the hypothalamo-thalamic system was found to participate in the response. With epileptoid signs present in the EEG, the drug could reduce the seizure threshold.

Eur Neurol 1978;17(1):50-5
Piracetam in the treatment of post-concussional syndrome. A double-blind study.

Hakkarainen H, Hakamies L.

The effect of piracetam, a cyclical derivative of GABA, was compared with that of a placebo in a double-blind study of 60 patients with post-concussional syndrome of 2-12 months' duration. The daily dose of piracetam was 4,800 mg. After 8 weeks of treatment piracetam significantly reduced the occurrence and severity of the following symptoms: vertigo, headache, tiredness, decreased alertness, increased sweating and neurasthenic symptoms. No significant effect was observed on the following symptoms: tremor, orthostatic symptoms, and memory disorders. Side effect were reported by 64% of the patients under piracetam and by 32% under placebo. In the author's opinion, piracetam seems to be a promising new drug for the treatment of post-concussional syndrome.

Lancet 1977 Nov 26;2(8048):1110-1
Effect of piracetam on level of consciousness after neurosurgery.

Richardson AE, Bereen FJ.

2-oxopyrollidine acetamide (piracetam) is said to protect the cerebral cortex against hypoxia. Since surgery is believed to aggravate cerebral hypoxia and the consequent neurological dysfunction, patients undergoing surgery for brain tumors or ruptured cerebral aneurysms were studied. A random, non-stratified study of 100 patients showed that a significantly higher percentage of patients receiving piracetam attain or maintain a normal or near-normal level of consciousness postoperatively than those receiving a placebo. No side-effects or interaction of piracetam with other medications were noted.

Acta Anaesthesiol Belg 1975 Apr;26(1):51-60
Clinical trial of piracetam in disorders of consciousness due to head injury.

Calliauw L, Marchau M.

The authors first remind some toxicological and some pharmacological properties of piracetam (Nootropil), then present the results of a test giving evidence of the presence of this drug in the cerebrospinal fluid after intravenous administration to man. In a double blind study, the activity of piracetam is tested on 31 patients suffering from coma after head injury. Only 27 patients without intracranial space occupying lesions are taken into account. Methods and results are described. Piracetam, although showing no activity on mortality, improves the level of consciousness.

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28/08/2019 9:43 am  

Piracetam In Healthy Adults

Clin Neurophysiol 2001 Feb;112(2):275-9
Piracetam affects facilitatory I-wave interaction in the human motor cortex.

Wischer S, Paulus W, Sommer M, Tergau F. Department of Clinical Neurophysiology, University of Goettingen, Robert-Koch-Strasse 40, D-37075, Goettingen, Germany.

OBJECTIVE: To investigate by means of transcranial magnetic stimulation (TMS) the effect of a single oral dose of the GABA derivate piracetam on intracortical facilitatory I-wave interaction. METHODS: The study was performed in 8 healthy volunteers. Before, 1, 3, 6, and 24 h after intake of 4000 mg piracetam, MEPs in the relaxed abductor digiti minimi muscle were elicited by a recently introduced double pulse TMS technique with a suprathreshold first and a subthreshold second stimulus. From interstimulus intervals of 0.5-5.1 ms 3 periods were observed in which MEP facilitation showed maxima - so-called peaks of I-wave interaction - and which were separated by two troughs with no facilitation. We studied the changes in timing and size of the peaks over time. RESULTS: With piracetam, I-wave peaks showed a reduction in size as well as a shortening of the latencies at which the peaks occurred. Both changes were significant at 6 h after drug intake compared to baseline. The effects were partially reversible after 24 h. CONCLUSIONS: The mode of action of piracetam within the nervous system is almost unknown. The peak size reduction was similar to effects that were seen under GABAergic drugs, although GABAergic properties of piracetam have not been observed so far. Shortening of the I-wave peak latencies is a new phenomenon. The results are discussed on the basis of the known therapeutic effects of piracetam in cortical myoclonus and as nootropic agent.

Int J Psychophysiol 1999 Oct;34(1):81-7
Single-dose piracetam effects on global complexity measures of human spontaneous multichannel EEG.

Kondakor I, Michel CM, Wackermann J, Koenig T, Tanaka H, Peuvot J, Lehmann D. The KEY Institute for Brain-Mind Research, University Hospital of Psychiatry, Zurich, Switzerland.

Global complexity of 47-channel resting electroencephalogram (EEG) of healthy young volunteers was studied after intake of a single dose of a nootropic drug (piracetam, Nootropil UCB Pharma) in 12 healthy volunteers. Four treatment levels were used: 2.4, 4.8, 9.6 g piracetam and placebo. Brain electric activity was assessed through Global Dimensional Complexity and Global Omega-Complexity as quantitative measures of the complexity of the trajectory of multichannel EEG in state space. After oral ingestion (1-1.5 h), both measures showed significant decreases from placebo to 2.4 g piracetam. In addition, Global Dimensional Complexity showed a significant return to placebo values at 9.6 g piracetam. The results indicate that a single dose of piracetam dose-dependently affects the spontaneous EEG in normal volunteers, showing effects at the lowest treatment level. The decreased EEG complexity is interpreted as increased cooperativity of brain functional processes.

Electroencephalogr Clin Neurophysiol 1993 Mar;86(3):193-8
Global dimensional complexity of multi-channel EEG indicates change of human brain functional state after a single dose of a nootropic drug.

Wackermann J, Lehmann D, Dvorak I, Michel CM. Department of Neurology, University Hospital, Zurich, Switzerland.

Viewing the multi-channel EEG as a sequence of momentary field maps corresponds to the concept of a trajectory in K-dimensional state space (K = number of channels). This approach permits a quantitative, single value measure of complexity of the brain state trajectory, the global correlation dimension that describes the ensemble characteristics of all recorded channels. In 5 normal volunteers, 4 records of 16-channel resting EEG were obtained during each of 4 randomized sessions (double blind design) after a single dose of placebo or 2.9 g or 4.8 g or 9.6 g piracetam. The global correlation dimension of a 40 sec epoch from each record was estimated, using 50 computational runs with 8192 point pairs. The results were combined for the two intermediate doses and averaged over repeated records. The dimensionality decreased from placebo (median = 5.89) to low dose (median = 5.72) to high dose (median = 5.59), significant in a Friedman ANOVA at P < 0.02, with significant differences between placebo vs. high and low vs. high dose. Thus, the subtle change of brain global functional state after a single dose of piracetam is reflected by the non-linear measure of global dimensional complexity of the multi-channel EEG.

Neuropsychobiology 1993;28(4):212-21
Single doses of piracetam affect 42-channel event-related potential microstate maps in a cognitive paradigm.

Michel CM, Lehmann D. Department of Neurology, University Hospital, Zurich, Switzerland.

We examined whether a single administration of piracetam produces dose-dependent effects on brain functions in healthy young men. In 6 subjects, 42-channel event-related EEG potential maps (ERP) were recorded during a task requiring subjects to watch single digits presented in a pseudorandom order on a screen and to press a button after all triplets of three consecutive odd or even digits. The ERP maps to the three digits of the correctly detected triplets were analyzed in terms of their mapped ERP field configuration (landscape). Different landscapes of the maps indicate different configuration of the activated neural population and therefore reflect different functional microstates of the brain. In order to identify these microstates, adaptive segmentation of the map series based on their landscapes was done. Nineteen time segments were found. These segments were tested for direct effects on brain function of three single doses of piracetam (2.9, 4.8 or 9.6 g) and a placebo given double-blind in balanced order. Piracetam mainly affected the map landscape of the time segments following the triplet's last digit. U-shaped dose-dependent effects were found; they were strongest after 4.8 g piracetam. Since these particular ERP segments are recognized to be strongly correlated to cognitive functions, the present findings suggest that single medium doses of piracetam selectively activate differently located or oriented neurons during cognitive steps of information processing.

Psychopharmacology (Berl) 1976 Sep 29;49(3):307-9
Increase in the power of human memory in normal man through the use of drugs.

Dimond SJ, Brouwers EM.

Nootropyl (Piracetam) a drug reported to facilitate learning in animals was tested for its effect on man by administering it to normal volunteers. The subjects were given 3x4 capsules at 400 mg per day, in a double blind study. Each subject learned series of words presented as stimuli upon a memory drum. No effects were observed after 7 days but after 14 days verbal learning had significantly increased.

Acta Psychiatr Scand 1976 Aug;54(2):150-60
Piracetam-induced improvement of mental performance. A controlled study on normally aging individuals.

Mindus P, Cronholm B, Levander SE, Schalling D.

A double-blind, intra-individual cross-over comparison of the mental performance of 18 aging, non-deteriorated individuals during two 4-week periods of piracetam (1-acetamide-2-pyrrolidone) and placebo administration was performed using conventional and computerized perceptual-motor tasks. In a majority of these tasks the subjects did significantly better when on piracetam than on placebo, a finding consistent with ratings completed by two independent observers. The findings indicate new avenues for the treatment of individuals with reduced mental performance possibly related to disturbed alertness--a neglected group of psychiatric condition.

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28/08/2019 10:05 am  

Piracetam In Hearing Disorders (Also Tinnitus & Vertigo)

Acta Otorrinolaringol Esp 2000 May;51(4):319-26
Pathophysiological rationale for the use of piracetam in sudden deafness

Garcia Callejo FJ, Velert Vila MM, Morant Ventura A, Orts Alborch MH, Marco Algarra J, Blay Galaud L. Servicio de ORL, Hospital Clinico Universitario, Valencia.

To determine if blood viscosity disorders affect the clinical course of idiopathic sudden deafness, we studied the usefulness of the rheoactive agent piracetam and prednisolone compared with steroid/vasodilator therapy. The piracetam group (n = 17) showed clinical improvement in 82.3% and a mean hearing gain in 54.1%, compared with 68.7% and 49.3%, respectively, for the group without piracetam (n = 6). In both groups, clinical severity correlated with increased whole blood viscosity and erythrocyte aggregability and filterability rates. On the seventh day after onset, all the viscosity parameters had returned to normal in the piracetam group, but the non-piracetam group still showed no improvement in whole blood viscosity and erythrocyte filterability. Piracetam seemed to be effective in this sensorineural deafness, probably as a result of its effect on the viscoelastic properties of blood. Measurement of these properties seven days after beginning therapy provides information about long-term potential for hearing recovery.

Acta Otorrinolaringol Esp 1997 Jan-Feb;48(1):21-5
Sudden hearing loss. Treatment with piracetam

Solanellas Soler J, Esteban Ortega F, Soldado Patino L, Jimenez Morales JM. Servico ORL, Hospital Universitario de Valme, Sevilla.

From January 1993 to December 1994, 9 patients (median age 40 years, range 29-71) were evaluated for sudden hearing loss at the Valme de Sevilla University Hospital, Spain. All had severe or profound initial hearing loss, which was bilateral in 3 (33%) cases. Total deafness affected 5 (41%) ears. All subjects were treated with a 3-day course of intravenous piracetam, 10 g/day diluted in 250 ml of saline solution and administered in a 15-minute intravenous infusion. No side effects occurred. The parameters examined were age, sex, side of lesion, contralateral hearing status, time from onset of symptoms to admission, vestibular symptoms, tinnitus, erythrocyte sedimentation rate, initial hearing loss, and audiogram configuration. After treatment, 6 (50%) ears showed improved hearing. Eight (89%) patients had vestibular symptoms, and 5 (55%) reported tinnitus.

Fortschr Med 1995 Jun 30;113(18):288-90
Piracetam infusions in acute tinnitus and sudden deafness

Gutmann R, Mees K. Klinik und Poliklinik fur Hals-, Nasen- und Ohrenkranke, Ludwig-Maximilians-Universitat Munchen.

In a prospective randomised clinical study on 39 patients with tinnitus and sudden hearing loss the therapeutic efficacy of piracetam/HAES 6% was compared with that of naftidrofuryl/HAES 6%. The two groups of patients were comparable in terms of demographic and audiological baseline data. The parameters evaluated were hearing improvement and the reduction in intensity of tinnitus. Improvement in hearing was 15 dB (piracetam) versus 18.5 dB (naftidrofuryl). The improvement in tinnitus amounted 27 dB (piracetam) and 19.9 dB (naftidrofuryl). Both differences were not significant. Tolerability was very good in both groups. Piracetam, which improves rheology and has a positive effect on metabolism, would appear of particular interest for the treatment of acute tinnitus.

An Otorrinolaringol Ibero Am 1999;26(3):271-91
The effect of pharmacological treatment in the compensation of vertigo

Pons Rocher F. Servicio de O.R.L. Hospital Dr. Peset-S.V.S. Valencia.

From the age of sixty, vertigo is mainly due to vertebro-basilar insufficiency. It has been described that the association of Dihydroergocristine-Piracetam (D-P) is a useful treatment for vertebro-basilar insufficiency. That is why we have designed a comparative study between D-P an a Placebo, so that to prove if this association can be usefull in the treatment of vertigo occasioned by cerebrovascular insufficiency. Fifty patients complaining of vertigo were included in the study after an untreated term. 19 received a daily capsule of Placebo, and the other 31, treated with D-P, were divided in two groups: 16 patients received a dose of 3 mg Dihydroergocristine + 1.6 g Piracetam every 12 hours per os; and 15 other were treated with 1.5 mg Dihydroergocristine + 0.8 g Piracetam every 8 hours during 90 days. The patients were evaluated at the beginning of the study and 90 days later, with anamnesis and vestibular tests. In the last consultation the patients autoevaluated themselves the effect and the tolerance to the drugs received. In the Placebo group it was observed an improvement or disappearance of vertiginous symptoms in the 68.5% of the cases, while with D-P was 93.7% at the dose of 3 mg Dihydroergocristine + 1.6 g Piracetam each 12 hours and 100% with the dose 1.5 mg Dihydroergocristine + 0.8 g Piracetam each 8 hours. None of the treated patients with D-P worsened their symptoms. We observe a considerable decrease in the number of patients with vegetative symptoms in the group treated with D-P related to the Placebo group, though the symptoms persisted more time in the group treated with D-P that in the Placebo group. The group treated with D-P get a higher percentage of improvements and disappearance of auditive and cervical symptoms that the groups treated with Placebo. In the vestibulo-spinal and cerebellous tests it was observed a better improvement with D-P at the dose of 1.5 mg of Dihydroergocristine + 0.8 g Piracetam each hours compared with the other two groups. It can be concluded that the association D-P is an effective treatment for vertigo, getting also a higher normalization of the vestibular tests than Placebo.

Pharmacopsychiatry 1999 Mar;32 Suppl 1:54-60
The effectiveness of piracetam in vertigo.

Oosterveld WJ. Department of Otorhinolaryngology, University of Amsterdam, The Netherlands.

Vertigo is a sensation of altered orientation in space and may be defined as an illusion of movement. It is a subjective symptom and therefore difficult to assess. Examination and diagnosis remain difficult. Although treatment should be directed at the underlying cause or disorder, the origin of vertigo is frequently unknown or untreatable. Pharmacotherapy is required for symptomatic treatment. Piracetam has been shown to be effective in vertigo of both central and peripheral origin. It is thought to act on vestibular and oculomotor nuclei in the brain stem and thus on the central control of balance enhancing mechanisms of compensation and habituation. This review of double-blind trials shows that piracetam alleviates vertigo after head injury, vertigo of central origin as, for example, in vertebrobasilar insufficiency and in peripheral vestibular disorders, especially in middle-aged and elderly subjects. Piracetam decreases the frequency but probably not the severity of exacerbations in patients with chronic or recurrent vertigo. The usual dosage of piracetam in vertigo is 2.4-4.8 g daily. Tolerability of piracetam is good and adverse effects have been mild and infrequent.

An Otorrinolaringol Ibero Am 1989;16(3):271-9
Clinical trial of the use of the combination of piracetam and dihydroergocristine in vertigo from different causes

Ordosgoitia H, Castro C, Carbayeda M, Labella T.

We report on the therapeutic effect of a combination of piracetam and dihydroergocristine in 55 vertiginous patients, of both sexes, between 20 and 67 years of age, from different causes (not scheduled for surgery). The trial lasted 3 months, and the drugs were taken twice daily. Aside from one case who stopped the drug therapy because of intolerance, the conclusions drawn by the AA. are seemingly good, both subjectively and objectively (audiometric and electronystagmographic tracings).

Ann Otolaryngol Chir Cervicofac 1986;103(4):283-5
Value of piracetam in the treatment of sudden idiopathic deafness. Preliminary report

Gersdorff M, Franceschi D.

The authors report 10 cases of sudden deafness treated by piracetam. In eight cases there was a complete recovery, in one case there was a partial recovery and in one it was a failure. There was observed in two cases a rise in the compound action potential of the electrocochleography measured after 30 minutes of the infusion in comparison with that performed 30 minutes before the infusion. They were impressed by the rapidity of the recovery and they did not encounter side effects.

S Afr Med J 1985 Nov 23;68(11):806-8
The use of piracetam in vertigo.

Fernandes CM, Samuel J.

A pilot study with piracetam (Nootropil; UCB) was performed in 5 selected dizzy patients who had a diagnosis of presbyvertigo or vertebrobasilar insufficiency. The study was monitored by assessing the effect of piracetam on the pursuit-tracking system. All patients showed a remarkable improvement in their pursuit tracking, in addition to marked subjective improvement in their vertigo.

Arzneimittelforschung 1980;30(11):1947-9
The efficacy of piracetam in vertigo. A double-blind study in patients with vertigo of central origin.

Oosterveld WJ.

In a double-blind trial according to a switchback design with 4 periods of one week each a comparison was made between the effects of piracetam and a placebo. In 22 patients with vertigo of central origin (posttraumatic, psychogenic, ecileptogenic and hypertensive vertigo were excluded) piracetam was found to significantly reduce symptoms. On anamnestic examination the patients noted the effect of both substances on vertigo, motility disturbances, vitality and sleep. Piracetam was found to have a significant effect on the first three. The effect of piracetam is explained by an enhanced control of the cerebral cortex on the subordinated vestibular centers, in agreement with findings in the literature on animal and human pharmacology.

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28/08/2019 2:04 pm  

Piracetam In Raynaud's Phenomenon

Arzneimittelforschung 1993 May;43(5):526-35
Treatment of the Raynaud's phenomenon with piracetam.

Moriau M, Lavenne-Pardonge E, Crasborn L, von Frenckell R, Col-Debeys C. Department of Internal Medicine, University of Louvain, UCL, Brussels Belgium.

Piracetam (Nootropil, CAS 7491-74-9) has been investigated in the treatment of primary and secondary Raynaud's phenomenon in three sequential and complementary studies. The first study in 20 patients with primary Raynaud's phenomenon, utilising clinical and ultrasound examination, capillaroscopy and laboratory tests established a daily dose of 8 g as most effective. The second study in 58 patients (47 primary, 11 secondary) confirmed the therapeutic efficacy of piracetam in both primary and secondary Raynaud's phenomenon. The third study, of crossover design, in 30 patients with severe Raynaud's syndrome, examined various agents given singly or in combination. The results not only confirmed the efficacy of piracetam but in addition allowed comparison of the efficacy of the principal therapeutic agents or regimens used in the treatment of Raynaud's syndrome and the formulation of a list of these therapies in decreasing order of efficacy, thus: piracetam 4 g/d + buflomedil 600 mg/d; piracetam 8 g/d; buflomedil 600 mg/d; piracetam 4 g/d + acetylsalicylic acid 100 mg/d; pentoxifylline 1200 mg/d; calcium antagonists; ketanserin 120 mg/d. The particular efficacy of 8 g piracetam daily in 3 divided doses at 8-hourly intervals can be attributed to its unique dual mode of action; inhibition of platelet function by inhibition of thromboxane A2 synthetase or antagonism of thromboxane A2 and increased formation of prostaglandin I2, together with a rheological effect involving reduction in blood and plasma viscosity through an increase in cell membrane deformability and a reduction of 30-40% in the plasma concentrations of fibrinogen and von Willebrand's factor. In addition, the administration of piracetam appears to be devoided of adverse effects.

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28/08/2019 2:30 pm  

Piracetam In Schizophrenia

J Clin Pharm Ther 1999 Oct;24(5):369-74
Piracetam in the treatment of schizophrenia: implications for the glutamate hypothesis of schizophrenia.

Noorbala AA, Akhondzadeh S, Davari-Ashtiani R, Amini-Nooshabadi H. Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran.

OBJECTIVE: There is a growing interest in investigating the role of glutamate receptors in the pathophysiology of schizophrenia. Indeed, the hyperdopaminergic theory of schizophrenia can explain only the positive symptoms of schizophrenia, whereas the glutamate hypothesis may provide a more comprehensive view of the illness. We undertook a trial to investigate whether the combination of haloperidol with piracetam, a nootropic agent which modulates the glutamate receptor positively was more effective than haloperidol alone. METHODS: Thirty patients who met the DSM IV criteria for schizophrenia completed the study. Patients were allocated in a random fashion, 14 to haloperidol 30 mg/day plus piracetam 3200 mg/day and 16 to haloperidol 30 mg/day plus placebo. RESULTS: Although both protocols significantly decreased the score of the positive symptoms, the negative symptoms, the general psychopathological symptoms and the total score of PANSS scale over the trial period, the combination of haloperidol and piracetam showed a significant superiority over haloperidol alone in the treatment of schizophrenic patients. CONCLUSION: Piracetam, a member of the nootropic class of drugs and a positive modulator of glutamate receptor, may be of therapeutic benefit in treating schizophrenic patients in combination with typical neuroleptics. However, a larger study to confirm our results is warranted.

Psychopharmacology (Berl) 1979 Sep;64(3):341-8
Some effects of piracetam (UCB 6215, Nootropyl) on chronic schizophrenia.

Dimond SJ, Scammell RE, Pryce IG, Huws D, Gray C.

A study is described of effects of a nootropic drug on chronic schizophrenia. The nootropic drugs act on the central nervous system with the cerebral cortex as their target. Chronic schizophrenic patients on the drug showed improvement in object naming and in tests where the patient was required to indicate the number of times he had been tapped. Improvements were also noted in learning and memory tasks. In dichotic listening the patients showed a reduction in the amount of incorrect verbal responses produced. There were no improvements in symptom rating or social behaviour rating. These results suggest some cognitive improvement but little if any change in the disease state of the patient.

J Int Med Res 1979;7(4):277-84
Biological correlates of piracetam clinical effects in psychotic patients.

Kabes J, Erban L, Hanzlicek L, Skondia V.

The purpose of this controlled clinical trial was to demonstrate possible correlations between changes in bioenergetic metabolism and psychotropic drug administration in the treatment of functional psychosis. The study included 26 patients, eleven with schizophrenia, three with chronic atypical depression and twelve with drug-resistant endogenous depressions. All patients were kept on continuous psychotropic medication for at least 3 weeks before starting the trial, and piracetam was given additionally in a fixed dosage of 2400 mg daily; the same number of identical capsules was given during the pre- and post-treatment placebo periods. Psycho-pathological evaluation of the patients was by the BPRS; clinical and biochemical data were evaluated statistically by the analysis of regression. The results show that in schizophrenic patients an improvement was observed in those cases who had improved biochemically, i.e. where the ATP values had increased. In drug-resistant depressions there was a rapid and significant clinical improvement after piracetam co-administration, and this went in step with a significant rise in ATP levels.

Pharmakopsychiatr Neuropsychopharmakol 1975 Mar;8(2):82-9
Pilot study of 2-pyrrolidon-acetamid (generic name: piracetam)

Tacke B, Freistein H, Kempf H, Windheuser A.

10 chronic schizophrenics were tested by clinical observations, psychological tests (FPI, LEV, d 2) and ratings with the Wittenborn-Psychiatric-Ratings-Scales (WPRS) before and after taking 2-pyrrolidon-acetamid. The improvement of obstructive, apathy, withdrawal and affective flatness in 7 patients justify a double-blind psychometric evaluation concerning the effect of Piracetam on the schizophrenic deficiency states.

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28/08/2019 2:53 pm  

Piracetam In Stroke

Int J Clin Pharmacol Ther 2001 Apr;39(4):152-7
Restitution of alpha-topography by piracetam in post-stroke aphasia.

Szelies B, Mielke R, Kessler J, Heiss WD. Neurologische Universitatsklinik, Koln, Germany.

OBJECTIVE: Electroencephalographic and clinical effects of piracetam in post-stroke aphasia were evaluated in a prospective, randomized, double-blind, placebo-controlled trial. METHODS: In 24 patients with mild to moderate aphasia after ischemic stroke, quantitative topographic EEG at rest was studied before and after a 6-week treatment period. RESULTS: In the active treatment group, a significant shift in the alpha-rhythm from frontal to occipital regions was observed which may be due to a restitution of corticothalamic circuits involved in the generation of alpha-activity. CONCLUSION: Neuropsychological scores improved significantly and markedly in various domains of speech during piracetam treatment, whereas improvements were less marked and restricted to a few categories in the placebo group.

J Neurol Sci 2000 Dec 1;181(1-2):65-72
Piracetam versus acetylsalicylic acid in secondary stroke prophylaxis. A double-blind, randomized, parallel group, 2 year follow-up study.

Grotemeyer KH, Evers S, Fischer M, Husstedt IW. Department of Neurology, Klinikum Saarbrucken gGmbH, Winterberg 1, D-66119, Saarbrucken, Germany. kh.grotemeyer@rz.uni-sb.de

Piracetam has been shown to inhibit platelet aggregation. Therefore, we performed a double-blind, randomized, parallel group study to compare the efficacy of daily 1600 mg piracetam t.i.d. vs. 200 mg acetylsalicylic acid (ASA) t.i.d. in secondary stroke prophylaxis. 563 patients after stroke as confirmed by computed tomography (CT) or magnetic resonance imaging (MRI) were enrolled and received either piracetam or ASA during a 2 year follow-up period. The primary endpoint was the rate of stroke, transient ischaemic attack (TIA), or death from vascular cause. The secondary endpoint was the rate of adverse events leading to a premature discontinuation of the study medication. Patients were visited at home every 3 months and were examined in hospital after 1 and 2 years. At every visit, the platelet function was evaluated. No significant difference and no significant equivalence could be shown for the primary endpoint between the piracetam and the ASA group both in the intention-to-treat and in the per-protocol analysis. However, there was a not significant trend in favor of ASA (11.7 vs. 15.2%). After excluding those patients who did not respond to antiplatelet medication in vitro, however, piracetam and ASA were equivalent in secondary stroke prophylaxis (stroke, TIA, or vascular death 10.1% in the piracetam group vs. 9.7% in the ASA group). Piracetam was significantly superior to ASA in the secondary endpoint (P=0.0039). The data suggest that the overall efficacy of piracetam in secondary stroke prophylaxis is not as good as that of ASA but that piracetam is better tolerated. However, our data furthermore show that nonresponders to pharmacological inhibition of platelet function are more frequent under piracetam therapy and that they may influence the results of large studies on secondary prophylaxis in vascular diseases.

Stroke 2000 Sep;31(9):2112-6
Piracetam improves activated blood flow and facilitates rehabilitation of poststroke aphasic patients.

Kessler J, Thiel A, Karbe H, Heiss WD. Max-Planck-Institute for Neurological Research, Cologne, Germany.

BACKGROUND AND PURPOSE: In a prospective, double-blind, placebo-controlled study, it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow. METHODS: Twenty-four stroke patients with aphasia were randomly allocated to 2 groups: 12 patients received 2400 mg piracetam twice daily, 12 placebo. Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy, the patients were examined neuropsychologically and studied with H(2)(15)O PET at rest and during activation with a word-repetition task. Blood flow was analyzed in 14 language-activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images. RESULTS: Before treatment, both groups were comparable with respect to performance in language tasks and to type and severity of aphasia. In the piracetam group, increase of activation effect was significantly higher (P:<0.05) in the left transverse temporal gyrus, left triangular part of inferior frontal gyrus, and left posterior superior temporal gyrus after the treatment period compared with the initial measures. The placebo group showed an increase of activation effect only in the left vocalization area. In the test battery, the piracetam group improved in 6 language functions, the placebo group only in 3 subtests. CONCLUSIONS: Piracetam as an adjuvant to speech therapy improves recovery of various language functions, and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere.

Pharmacopsychiatry 1999 Mar;32 Suppl 1:38-43
The role of piracetam in the treatment of acute and chronic aphasia.

Huber W. Department of Neurology and School of Logopedics, Rheinisch-Westfalische Hochschule (RWTH), Aachen, Germany.

Piracetam has been shown to improve speech in aphasic patients. This paper reviews the evidence for this benefit in aphasic patients with acute stroke and, in conjunction with language treatment, in post-acute and chronic aphasia. Early double-blind, placebo-controlled trials in acute stroke showed improvement in several neurologic parameters including aphasia. Subsequently two randomized double-blind placebo-controlled studies were performed which utilised the Aachen Aphasia Test (AAT), a validated and standardized procedure, to assess language function. Patients received placebo or piracetam 4.8g daily for 12 weeks in one study and for 6 weeks in the other. In both studies patients received concomitant intensive speech therapy; one included patients 6-9 weeks after stroke while in the other the duration of aphasia varied between 4 weeks and 3 years. Compared with placebo there was improvement in both studies on piracetam in all 5 subtests of the AAT and significant overall improvement in aphasia. This indicated that, given in conjunction with language therapy, piracetam improved speech in patients with post-acute and chronic aphasia. In the Piracetam in Acute Stroke Study (PASS), of 927 patients treated within 12 hours of the onset of acute ischemic stroke, 373 were aphasic. Treatment consisted of placebo or an intravenous bolus of 12g piracetam, 12g piracetam daily for 4 weeks and 4.8 g daily for a further 8 weeks. After 12 weeks significantly more patients (approximately 10%, P=0.04) had recovered from aphasia on piracetam than placebo while in 197 patients treated within 7 hours of stroke onset, the difference in favor of piracetam was 16% (P= 0.02). These studies indicate that piracetam improves aphasia in acute stroke and, as an adjuvant to language therapy, in post-acute and chronic aphasia.

Pharmacopsychiatry 1999 Mar;32 Suppl 1:33-7
The clinical safety of high-dose piracetam--its use in the treatment of acute stroke.

De Reuck J, Van Vleymen B. Department of Neurology, University Hospital, Ghent, Belgium.

Recent post-marketing surveillance reports have confirmed the benign safety profile and lack of organ toxicity shown by piracetam during its 25 years of clinical usage. Tolerance has proved equally good with the more recent use of larger doses (up to 24 g/day) for the long-term control of cortical myoclonus and when given intravenously to patients with acute stroke. This paper provides a brief review of these findings and records the safety of piracetam as found in the Piracetam in Acute Stroke Study (PASS), a randomized multicenter placebo-controlled study in 927 patients with acute ischemic stroke. Patients receive one intravenous bolus injection of placebo or 12 g piracetam, piracetam 12 g daily for 4 weeks and maintenance treatment for 8 weeks. The major results have been reported (De Deyn et al., Stroke 28 [1997] 2347-2352). Safety was assessed taking into account adverse events including abnormal laboratory test results and mortality. Death within 12 weeks occurred more frequently in the piracetam group but the difference from placebo was not significant. Of many potential risk, prognostic and treatment-related factors examined by logistic regression, 6 contributed significantly to death of which the most important were initial severity of stroke and age. Neither treatment nor any treatment-related factor contributed significantly to death. Adverse events were similar in frequency, type and severity in piracetam and placebo groups. Events of cerebral, non-cerebral and uncertain origin likewise occurred with similar frequency. Few patients discontinued because of adverse events. There was no difference between treatments in the frequency of events associated with bleeding, including hemorrhagic transformation of infarction. An important finding was that, of 31 patients with primary hemorrhagic stroke enrolled, 3 piracetam-treated patients died compared with 6 on placebo. The results suggest that piracetam in high dosage may be given to patients with acute stroke without significant adverse effects.

Pharmacopsychiatry 1999 Mar;32 Suppl 1:25-32
Piracetam in the treatment of acute stroke.

Orgogozo JM. Department of Neurology, Pellegrin Hospital, University of Bordeaux II, France.

The neuroprotective properties of the nootropic agent piracetam together with reported hemorrheologic and antithrombotic effects provided the rationale for the evaluation of piracetam in acute stroke. Pilot studies showed an increase in compromised regional cerebral blood flow and improvement in motor function, aphasia and level of consciousness. Subsequently the Piracetam in Acute Stroke Study (PASS) was performed and the chief results have recently been reported (Stroke 28 (1997) 2347-2352). This was a multicenter double-blind trial in 927 patients to determine whether, compared with placebo, piracetam improved outcome when given within 12 hours of the onset of acute ischemic stroke, confirmed by computed tomography within 24 hours of admission (but not necessarily prior to treatment). Patients received an initial iv bolus of placebo or 12g piracetam, 12g piracetam daily for 4 weeks and maintenance treatment for a further 8 weeks. Neurologic status at 4 weeks was the primary end point; secondary outcome measures were functional outcome and aphasia at 12 weeks. Results in aphasic patients have not previously been reported. Analysis was planned both in all patients (n = 927) and an early treatment subgroup (n = 460) treated within 6 hours of stroke onset. This period was subsequently redefined as 7 hours. Intention-to-treat analyses in the total population showed a significant (P = 0.04) increase compared with placebo in the number of patients recovered from aphasia but no significant neurologic or functional improvement. Post hoc analysis in the early treatment subgroup showed improved neurologic outcome (P = 0.07), better function (P = 0.02) and a greater recovery rate from aphasia (P = 0.02). Additional analysis in this early treatment subgroup confined to 360 patients with moderate and severe stroke showed significant improvement in all 3 outcomes. There was no significant difference in mortality between treatment groups after 12 weeks. There were fewer deaths in piracetam-treated patients in those patients in the intention-to-treat population admitted with primary hemorrhagic stroke.

Wiad Lek 1998;51(7-8):321-5
[Porownanie skutecznosci piracetamu i dekstranu 40 tys. u chorych w podeszlym wieku z niedokrwiennym udarem mozgu.] [Piracetam In Stoke Induced Aphasia]

[Article in Polish]
Kozubski W. Katedry i Kliniki Neurologii Akademii Medycznej im. K. Marcinkowskiego w Poznaniu.

Piracetam is believed to restore the metabolism of glucose and 02, and also to prevent the vasospasm of small arteries in the penumbra of ischaemic focus. Taking the above into account we tried to estimate its effect in elderly patients with stroke. The studied group consisted of 47 patients, aged 60-78 years (mean 67,4 yrs), with the first ischaemic episode. 23 patients were treated with 500 ml of Dextran 40 daily and 60 ml of placebo given separately. The rest of the patients was treated with the same dose of Dextran 40 and 12 g of Piracetam as 60 ml i.v. bolus. The neurological status of the patients was estimated using Scandinavian Neurological Stroke Scale (SNSS). In the patients treated with Dextran and placebo there were no changes in the total score of SNSS, both after 10 and 28 days, comparing with the initial status. In the patients treated with Dextran and Piracetam total SNSS score improved significantly after 10 days (p < 0.05) and the effect was increased after 28 days (p < 0.02). The effect of the treatment with Piracetam was especially accentuated in the patients with aphasia (n = 13), whose status showed the most powerful improvement both after 10 (p < 0.03) and 28 days (p < 0.02). The author believes that Piracetam instituted within the first hours after stroke might improve the neurological status of the patients, especially those with aphasia.

Neurol Neurochir Pol 1997 Nov-Dec;31(6):1101-9
Piracetam treatment in ischemic stroke

Tomczykiewicz K, Domzal T. Kliniki Neurologicznej Centralnego Szpitala Klinicznego Wojskowej Akademii Medycznej, Warszawie.

The increase of interest in piracetam in the treatment of stroke has been noticed lately. The reason of that is the unique double-action of this drug which depends on: 1. its effect on vascular system, and 2. improving of the metabolic process in a nerve cell. The purpose of our work was the evaluation of the therapeutic action of piracetam in comparison with other drugs, which are applied in treating stroke. 171 patients were examined, and piracetam was given to 40 of them. The effects of the treatment were evaluated after 14 days of using piracetam in dose of 12.0 g i.v. The authors estimate, that this drug is efficient in ischaemic stroke. However, its definite superiority over other drugs has not been firmly stated.

Zh Nevrol Psikhiatr Im S S Korsakova 1997;97(10):29-34
Nootropil in the treatment of disorders of the higher mental functions in patients with an ischemic stroke

Burd GS, Gekht AB, Bogolepova AN, Buklina SB.

47 patients with acute ischemic stroke were treated with nootropil (pyracetam, UCB, Belgium) from the first day of the disease (12 g, intravenously, by drops during 2 weeks, then 4.8 g, per os) on the background of basic therapy. There was revealed increase of spontaneous activity, expressive and impulsive speech, audio- and speaking memory (especially delayed memory), tactile, acoustic and visual gnosis, space praxis. There was observed more pronounced positive dynamics of functions of damaged hemisphere in patients with localisation of ischemic focus in left hemisphere. Meanwhile restoration was slower when ischemic focus was localized in right hemisphere. Restoration of high mental functions occurred to be faster during nootropil treatment as compared with basic therapy only. The conclusion was made that nootropil can be prescribed for the patients with hemispheric ischemic stroke and especially for the patients with alterations of cerebral circulation in system of internal carotid artery including such disturbances on the background of insufficiency of circulation in vertebrobasilar system.

Stroke 1997 Dec;28(12):2347-52
Treatment of acute ischemic stroke with piracetam. Members of the Piracetam in Acute Stroke Study (PASS) Group.

De Deyn PP, Reuck JD, Deberdt W, Vlietinck R, Orgogozo JM. Department of Neurology, Middelheim Hospital, Antwerp, Belgium.

BACKGROUND AND PURPOSE: Piracetam, a nootropic agent with neuroprotective properties, has been reported in pilot studies to increase compromised regional cerebral blood flow in patients with acute stroke and, given soon after onset, to improve clinical outcome. We performed a multicenter, randomized, double-blind trial to test whether piracetam conferred benefit when given within 12 hours of the onset of acute ischemic stroke to a large group of patients. METHODS: Patients received placebo or 12 g piracetam as an initial intravenous bolus, 12 g daily for 4 weeks and 4.8 g daily for 8 weeks. The primary end point was neurologic outcome after 4 weeks as assessed by the Orgogozo scale. Functional status at 12 weeks as measured by the Barthel Index was the major secondary outcome. CT scan was performed within 24 hours of the onset of stroke but not necessarily before treatment. Analyses based on the intention to treat were performed in all randomized patients (n = 927) and in an "early treatment" population specified in the protocol as treatment within 6 hours of the onset of stroke but subsequently redefined as less than 7 hours after onset (n = 452). RESULTS: In the total population, outcome was similar with both treatments (the mean Orgogozo scale after 4 weeks: piracetam 57.7, placebo 57.6; the mean Barthel Index after 12 weeks: piracetam 55.8, placebo 53.1). Mortality at 12 weeks was 23.9% (111/464) in the piracetam group and 19.2% (89/463) in the placebo group (relative risk 1.24, 95% confidence interval, 0.97 to 1.59; P = .15). Deaths were fewer in the piracetam group in those patients in the intention-to-treat population admitted with primary hemorrhagic stroke. Post hoc analyses in the early treatment subgroup showed differences favoring piracetam relative to placebo in mean Orgogozo scale scores after 4 weeks (piracetam 60.4, placebo 54.9; P = .07) and Barthel Index scores at 12 weeks (piracetam 58.6, placebo 49.4; P = .02). Additional analyses within this subgroup, confined to 360 patients with moderate and severe stroke (initial Orgogozo scale score < 55), showed significant improvement on piracetam in both outcomes (P < .02). CONCLUSIONS: Piracetam did not influence outcome when given within 12 hours of the onset of acute ischemic stroke. Post hoc analyses suggest that piracetam may confer benefit when given within 7 hours of onset, particularly in patients with stroke of moderate and severe degree. A randomized, placebo-controlled, multicenter study, the Piracetam Acute Stroke Study II (PASS II) will soon begin.

Clin Neuropharmacol 1994 Aug;17(4):320-31
Effect of piracetam on recovery & rehabilitation after stroke: a double-blind, placebo-controlled study.

Enderby P, Broeckx J, Hospers W, Schildermans F, Deberdt W. Speech and Language Therapy Research Unit, Frenchay Hospital, Bristol, England.

The nootropic agent piracetam has been shown to improve learning and memory, and it may, by this means, facilitate recovery and rehabilitation after a stroke. We report the results of a pilot study exploring its effects in patients undergoing rehabilitation after acute cerebral infarction in the carotid artery territory. We compared piracetam and placebo, each given for 12 weeks, in a multicenter, double-blind, randomized trial of parallel-group design; testing was performed at baseline (6-9 weeks poststroke), weeks 5 and 12, and, in fewer patients, 12 weeks after termination of treatment. Standardized tests of activities of daily living (Barthel Index, Kuriansky Test), aphasia (Aachen Aphasia Test), and perception (Rivermead Perception Assessment Battery) were the primary efficacy variables. Of 158 patients, 137 (81 males, 56 females) were studied after treatment and 88 at 24-week follow-up. Thirty patients on piracetam (45%) and 37 on placebo (53%) were aphasic on entry. Both groups, including the subgroups with aphasia, were well matched at baseline for demographic data, stroke sequelae, type and severity of aphasia, and prognostic parameters. Multivariate analysis of Aachen Aphasia subtest scores showed a significant overall improvement relative to baseline in favor of piracetam (p = 0.02) at 12 weeks. This was not seen at 24 weeks when, however, fewer patients were available for evaluation so that we could neither confirm nor deny whether improvement was maintained after cessation of piracetam. We were unable to demonstrate an effect on tests of activities of daily living and could neither confirm nor exclude an effect on perceptual deficit. We have shown an improvement in aphasia in patients undergoing rehabilitation after a stroke after 12 weeks' treatment with piracetam that requires confirmation in further studies.

Arch Phys Med Rehabil 1997 Mar;78(3):245-50
Piracetam as an adjuvant to language therapy for aphasia: a randomized double-blind placebo-controlled pilot study.

Huber W, Willmes K, Poeck K, Van Vleymen B, Deberdt W. Department of Neurology, School of Logopedics, Rheinisch-Westfalische Technische Hochschule (RWTH), Braine-l'Alleud, Belgium.

OBJECTIVE: To determine whether piracetam 4.8 g/day together with intensive language therapy improved language function more than language therapy alone. DESIGN: Double-blind, placebo-controlled parallel group study. SETTING: Referral speech and language clinic of a university department of neurology. PATIENTS: Sixty-six inpatients with aphasia present between 4 weeks and 36 months. INTERVENTIONS: Intensive language therapy for 6 weeks in all patients. Thirty-two patients received piracetam 4.8 g daily and 34 patients received placebo. MAIN OUTCOME MEASURE: The Aachen Aphasia Test (AAT), a standardized procedure for evaluating the severity of aphasia, was performed at baseline and after 6 weeks' treatment. RESULTS: In 50 patients evaluated for efficacy, a trend toward improvement in the active group was observed in all subtests of the AAT. This trend was statistically significant for absolute differences in recovery of "written language" and "profile level." CONCLUSION: Piracetam appears to have a positive adjuvant effect on the recovery of aphasia in patients receiving intensive language therapy.

Neurol Neurochir Pol 1991 Nov-Dec;25(6):731-6
Effect of piracetam on inorganic phosphates and phospholipids in the blood of patients with cerebral infarction in the earliest period of the disease

Kawiak W, Pilarczyk M, Chmielewska B, Gieracz-Nazar A. Katedry i Kliniki Neurologii Akademii Medycznej, Lublinie.

The influence of piracetam on the level of inorganic and phospholipid phosphorus in blood of ischemic stroke patients was evaluated. In healthy patients piracetam (2G, i.v.) diminished the concentration of inorganic phosphorus and essentially lowered the content of ion connected with phospholipids. In stroke patients inorganic phosphorus was primarily enhanced and organic lowered. Treatment with piracetam lowered the concentration of both inorganic and phospholipid phosphorus in blood.

Pharmacopsychiatry 1999 Mar;32 Suppl 1:44-8
Piracetam and platelets--a review of laboratory and clinical data.

Evers S, Grotemeyer KH. Department of Neurology, University of Munster, Germany.

This paper reviews the effects of piracetam on platelet function and the evidence for its antiplatelet effect which is mediated mainly by inhibition of platelet aggregation. Piracetam also possesses antithrombotic activity in vivo. It has been shown to normalize platelet aggregation in patients with increased platelet aggregability in various disorders including acute stroke, transient cerebral ischemic attacks and diabetes mellitus. This, together with clinical improvement, has also been shown in patients with Raynaud's phenomenon. The results of recent studies are presented in which piracetam showed similar efficacy to aspirin in the secondary prophylaxis of ischemic stroke.

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28/08/2019 3:20 pm  

Piracetam In Myoclonus Epilepsy

Arch Neurol 2001 May;58(5):781-6
Long-term efficacy and safety of piracetam in the treatment of progressive myoclonus epilepsy.

Fedi M, Reutens D, Dubeau F, Andermann E, D'Agostino D, Andermann F. FRCP©, Montreal Neurological Institute and Hospital, 3801 University St, Room 127, Montreal, Quebec, Canada H3A 2B4.

BACKGROUND: Piracetam has been proven to be effective and well tolerated in the treatment of myoclonus in short-term studies. OBJECTIVE: To assess its long-term clinical efficacy, 11 patients with disabling myoclonus due to progressive myoclonus epilepsy were treated with piracetam in an open-label study. METHODS: Neurologic outcome (at the 1st, 6th, 12th, and 18th month of treatment) was assessed by an adjusted sum score of the following 3 indices: motor impairment, functional disability, and global assessment of disability due to myoclonus. Severity of other neurologic symptoms (seizure frequency and severity, dysarthria, and gait ataxia) also was assessed. Treatment with piracetam was initiated at a dose of 3.2 g/d that was gradually increased until stable benefit was noted (maximal dose in the trial was 20 g/d). Concomitant antiepileptic drugs were maintained at their previous dose. RESULTS: Statistically significant improvement in the total rating score was observed after introduction of piracetam at the 1st, 6th, and 12th month of treatment. Severity of other neurologic symptom scores did not improve significantly. Two patients reported drowsiness during the first 2 weeks of treatment. CONCLUSIONS: Piracetam given as add-on therapy seems to be an effective, sustained, and well-tolerated treatment of myoclonus. In patients with progressive myoclonus epilepsy, the efficacy of the drug increased during the first 12 months of treatment and then stabilized.

Nippon Yakurigaku Zasshi 2000 Oct;116(4):209-14
A pharmacological profile of piracetam (Myocalm), a drug for myoclonus

Tajima K, Nanri M. Taiho Pharmaceutical Co., Ltd., Tokyo, Japan.

Myoclonus is defined as shock-like, brief involuntary abnormal movements in muscle jerking caused by external stimuli; and it arises from progressive myoclonus epilepsy, post-anoxic encephalopathy and Alzheimer's disease, causing disabling symptoms. It is a rare syndrome but very difficult to control. Piracetam (2-oxo-1-pyrrolidineacetamide, Myocalm) was developed more than 30 years ago as a cyclic derivative of gamma-aminobutyric acid (GABA); it has been used in European countries for the treatment of memory loss and other cognitive defects in patients. Some reports have suggested that piracetam has anti-myoclonus activities, but the mechanisms of myoclonus are not well-identified, and thus there have been few preclinical studies on piracetam for the treatment of myoclonus. We investigated the effect of piracetam and clonazepam, an anti-epileptic drug, on high dosage urea-induced myoclonus using an electromyogram in rats. The incidence of myoclonus induced by urea 4.5 g/kg (i.p.) was significantly reduced by piracetam at 300 mg/kg (i.p.) and by clonazepam at 0.3 mg/kg (p.o.). The coadministration of piracetam 100 mg/kg (i.p.) and clonazepam at 0.03-0.1 mg/kg (p.o.) significantly reduced the incidence of myoclonus, although separate administration was not effective. After oral administration of piracetam, it is rapidly and completely absorbed and excreted almost unchanged in the urine; however, it does show a little binding to human serum protein. Repeated oral administration of piracetam for 7 days in phase-I trials did not show any accumulation of the drug. In the placebo-controlled double-blind crossover trial of piracetam conducted in the UK, there was a significant improvement in cortical myoclonus. In phase-II trials, piracetam inhibited myoclonus and showed an improvement in the quality of life (QOL) of the patients. These results show that piracetam has a beneficial use in clinics for severe myoclonus patients when it is combined with anti-epileptic drugs, demonstrating an improvement in the myoclonus and QOL of patients.

J Int Med Res 1999 Jul-Aug;27(4):201-5
Beneficial effect of piracetam monotherapy on post-ischaemic palatal myoclonus.

Karacostas D, Doskas T, Artemis N, Vadicolias K, Milonas I. B' Department of Neurology, Aristotelian University School of Medicine, AHEPA Hospital, Thessaloniki, Greece.

A 70-year-old hypertensive woman suffered a subarachnoid haemorrhage followed by delayed vasospasm in the basal cerebral arteries. This resulted in multiple ischaemic lesions in the right middle cerebral artery region and contralateral post-ischaemic palatal myoclonus. In this setting, piracetam administered in high doses (24-36 g/day), abolished the myoclonus observed in this patient. Although there is evidence from case reports and clinical trials of the therapeutic efficacy of piracetam in patients with skeletal myoclonus of various causes, to our knowledge this is the first report indicating the beneficial effect of piracetam monotherapy on post-ischaemic palatal myoclonus.

Pharmacopsychiatry 1999 Mar;32 Suppl 1:49-53
Piracetam in the treatment of cortical myoclonus.

Genton P, Guerrini R, Remy C. Centre Saint Paul, Marseille and Department of Neurophysiology, Hopital Pasteur, Nice, France.

This paper reviews existing publications on the use of piracetam for the treatment of cortical myoclonus of various etiologies and includes the personal experience of the authors in progressive myoclonus epilepsy. Two double-blind comparisons with placebo provided results, which allow recommendations for the dosage and usage of piracetam in cortical myoclonus. Wide individual variation (7-24g daily) exists in dosage requirements but responses are dose-related so that dosage should be increased until an optimum effect is obtained. Tolerability after long-term use of piracetam in high dosage has been very good and without toxicity or serious adverse effects. Side effects have been occasional, mild and transient. The authors present their experience of 12 patients with progressive myoclonus epilepsy in whom the administration of up to 45 g piracetam daily, when added to existing anti-epileptic treatment, caused marked and sometimes spectacular improvement and was without significant adverse effects. Improvement was maintained for up to 7 years. The use of piracetam for disabling cortical myoclonus of any etiology, either as an addition to existing antimyoclonic drugs or as monotherapy, may bring about profound improvement in disability and quality of life. Piracetam should be considered a first-line drug for the treatment of cortical myoclonus.

J Neurol Neurosurg Psychiatry 1998 Mar;64(3):344-8
Piracetam relieves symptoms in progressive myoclonus epilepsy: a multicentre, randomised, double blind, crossover study comparing the efficacy and safety of three dosages of oral piracetam with placebo.

Koskiniemi M, Van Vleymen B, Hakamies L, Lamusuo S, Taalas J. Haartman Institute, Department of Virology, University of Helsinki, Finland.

OBJECTIVE: To compare the efficacy, tolerability, and safety of three daily dosage regimens of oral piracetam in patients with progressive myoclonus epilepsy. METHODS: Twenty patients (12 men, eight women), aged 17-43 years, with classical Unverricht-Lundborg disease were enrolled in a multicentre, randomised, double blind trial of crossover design in which the effects of daily doses of 9.6 g, 16.8 g, and 24 g piracetam, given in two divided doses, were compared with placebo. The crossover design was such that patients received placebo and two of the three dosage regimens of piracetam, each for two weeks, for a total treatment period of six weeks and thus without wash out between each treatment phase. The primary outcome measure was a sum score representing the adjusted total of the ratings of six components of a myoclonus rating scale in which stimulus sensitivity, motor impairment, functional disability, handwriting, and global assessments by investigators and patients were scored. Sequential clinical assessments were made by the same neurologist in the same environment at the same time of day. RESULTS: Treatment with 24 g/day piracetam produced significant and clinically relevant improvement in the primary outcome measure of mean sum score (p=0.005) and in the means of its subtests of motor impairment (p=0.02), functional disability (p=0.003), and in global assessments by both investigator (p=0.002) and patient (p=0.01). Significant improvement in functional disability was also found with daily doses of 9.6 g and 16.8 g. The dose-effect relation was linear and significant. More patients showed clinically relevant improvement with the highest dosage and, in individual patients, increasing the dose improved response. Piracetam was well tolerated and adverse effects were few, mild, and transient. CONCLUSIONS: This study provides further evidence that piracetam is an effective and safe medication in patients with Unverricht-Lundborg disease. In addition, it shows that a dose of 24 g is highly beneficial, more effective than lower doses and that a dose-effect relation exists. There is considerable variation in optimal individual dosage.

Mov Disord 1996 Nov;11(6):691-700
Clinical trial of piracetam in patients with myoclonus: nationwide multiinstitution study in Japan. The Myoclonus/Piracetam Study Group.

Ikeda A, Shibasaki H, Tashiro K, Mizuno Y, Kimura J. Department of Brain Pathophysiology, Kyoto University School of Medicine, Japan.

Sixty patients with disabling myoclonus excluding mainly spinal myoclonus were treated by piracetam as an open-labeled study, and myoclonus score, neurological symptoms, functional disability, and intensity of myoclonus were scored before and after treatment, including a blinded video inspection. Electrophysiological correlation also was investigated before and after treatment. Piracetam was effective in myoclonus, especially that of cortical origin, in both monotherapy and polytherapy. Piracetam also had positive benefits on gait ataxia and convulsions but not on dysarthria, and feeding and hand writing improved much more significantly. Psychologically significant improvement was seen in decreased motivation, sleep disturbance, attention deficit, and depression, all of which might be possibly secondary benefits associated with improvement of myoclonus. There was no positive correlation between clinical and electrophysiological improvement. Tolerance was good, and side effects were transient. However, hematological abnormalities observed in at least two patients in the present study should be kept in mind when relatively large doses of piracetam are administered, especially in combination with other antimyoclonic drugs.

Mov Disord 1993;8(1):63-8
Effectiveness of piracetam in cortical myoclonus.

Brown P, Steiger MJ, Thompson PD, Rothwell JC, Day BL, Salama M, Waegemans T, Marsden CD. MRC Human Movement and Balance Unit, Institute of Neurology, London, England.

21 patients with disabling spontaneous, reflex, or action myoclonus due to various causes, who had shown apparent clinical improvement on introduction of piracetam, entered a placebo-controlled double-blind crossover trial of piracetam (2.4-16.8 g daily). All but one patient had electrophysiological evidence of cortical myoclonus. Patients were randomly allocated to a 14-day course of piracetam followed by identical placebo, or placebo followed by piracetam. 19 patients received piracetam/placebo in addition to their routine antimyoclonic treatment (carbamazepine, clonazepam, phenytoin, primidone, sodium valproate, or tryptophan plus isocarboxazid, alone or in combination) and two received piracetam/placebo as monotherapy. All patients were rated at the end of each treatment phase using stimulus sensitivity, motor, writing, functional disability, global assessment, and visual analogue scales. Ten of the 21 patients had to be rescued from the placebo phase of the trial because of a severe and intolerable exacerbation of their myoclonus. No patients required rescue from the piracetam phase of the double-blind trial. When the 21 patients were considered together, there was a significant improvement in motor, writing, functional disability, global assessment, and visual analogue scores during treatment with piracetam compared with placebo. The total rating score also improved significantly with piracetam, by a median of 22%. Piracetam, usually in combination with other antimyoclonic drugs, is a useful treatment for myoclonus of cortical origin.

Eur Neurol 1991;31(6):388-90
Abolition of photoparoxysmal response in progressive myoclonus epilepsy.

Paulus W, Ried S, Stodieck SR, Schmidt D. Neurologische Universitatsklinik Munchen, FRG.

We have investigated the effect of piracetam on photoparoxysmal responses in 3 patients with progressive myoclonus epilepsy. With doses of up to 10 g/day, elimination of photoparoxysmal responses was achieved in all 3 patients. Corresponding to EEG improvement, the clinical performance improved slightly in 2 patients and definitely in 1 patient when piracetam was added to their medication of valproate and clonazepam. According to our data, medical treatment of myoclonus with piracetam is justified particularly in myoclonus of cortical origin.

Clin Neuropharmacol 1986;9(1):58-64
Antimyoclonic action of piracetam.

Obeso JA, Artieda J, Luquin MR, Vaamonde J, Martinez Lage JM.

Five patients with myoclonus were treated with oral piracetam (8-9 g/day). All patients had action-sensitive and/or stimulus-sensitive myoclonus and enhanced amplitude of somatosensory evoked potentials. Piracetam produced a marked reduction of the myoclonus in the five subjects without side effects. In view of its excellent tolerance and synergism with other antimyoclonic drugs, we consider piracetam to be a very valuable drug for the treatment of patients with myoclonus of any origin.

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Piracetam In Sickle Cell Anemia

Acta Haematol 1996;96(4):221-6
Piracetam is useful in the treatment of children with sickle cell disease.

el-Hazmi MA, Warsy AS, al-Fawaz I, Opawoye AO, Taleb HA, Howsawi Z, Mohamed AA, Aly AW, Refai S, Sugathan PS, Rab AS, Ahmed HB, Abulaban M, Abdulkader AM, Farid M. College of Medicine, King Saud University, Riyadh, Saudi Arabia.

The management of children suffering from sickle cell disease [sickle cell anaemia (SCA) and sickle cell beta degree-thalassaemia (S beta degree-thal.)] has been the concern of all clinicians caring for these patients. Several agents have been tried for treatment, often limited by toxic side effects. Piracetam (2-oxo-l-pyrrolidine acetamide, Nootropyl), a cyclic derivative of gamma-amino butyrate, used for the treatment of psychosenescent syndromes with no known side effects, was considered as a possible therapeutic agent for sickle cell disease. Interest was focused on the use of piracetam when it was shown that it had an antisickling effect, both in vivo and in vitro. We initiated multicentre double-blind investigations in two groups of children suffering from sickle cell disease ranging in age from 3-6 to 6-12 years. The total number of patients included in the study were 87 (SCA = 79 and Hb S beta degree-thal. = 8) in 13 centres in 10 different regions of Saudi Arabia. Coded boxes of the drugs were received from the company (UCB) and were administered as intravenous infusion during crises and orally during the follow-up, for a period of up to 1 year. After decoding the code at the end of the study, the patients were grouped into those receiving placebo (n = 39), i.e. controls, or piracetam (n = 48), i.e. study cases. In terms of age, weight, height and severity index, number of blood transfusions received and number of hospitalization, both groups were statistically homogenous. Data analysis showed that the clinical severity of the disease, the number of crises, the extent of hospitalization and the blood transfusion requirements significantly decreased during piracetam treatment (p < 0.001), though no statistically significant changes occurred in the placebo group. However, in the levels of the haematological and biochemical parameters no significant changes were documented in both groups. In addition, the improvement in the clinical presentation of the disease continued even several months after discontinuation of the drug in the majority of the children, as judged from the low severity index value. Though our results point to the recommendation that piracetam can be used for the treatment of children suffering from sickle cell disease, both SCA and S beta degree-thal, it is advisable to conduct long-term and close follow-up treatment programmes using piracetam to establish its therapeutic value particularly in adults and to ascertain that there are no long-term toxic side effects.

J Clin Pathol 1987 Jan;40(1):99-102
Use of piracetam improves sickle cell deformability in vitro and in vivo.

Gini EK, Sonnet J.

Microsieving diluted suspensions of oxygenated sickle cell anaemia (HbSS) cells on polycarbonate filters shows that piracetam improves the red cell deformability in vitro. In vivo an oral intake of 160 mg/kg/day divided in four doses enhances the HbSS cell deformability as actively as it does in in vitro experiments. The drug is also able partially to restore the impaired deformability of physiologically deoxygenated HbSS cells. These findings are consistent with the results of clinical trials, which show that continuous treatment with piracetam reduces the incidence of vaso-occlusive crises in patients with sickle cell disease.

Am J Pediatr Hematol Oncol 1985 Fall;7(3):240-4
Incidence, effects, and management of sickle cell disease in Brazil.

Salzano FM.

45% of the 121 million persons who live in Brazil have morphological indications of Black admixture, and 5-6% of them are carriers of the hemoglobin S gene. But even in persons identified as white, the hemoglobin AS genotype is present in about 1%. The total number of people with sickle cell disease is estimated as 45,000. The present analysis is based in 409 patients studied in Rio de Janeiro. The observed frequency of deformities of the vertebrae (18%), bone infarcts (12%), and gnathopathy (4%) was lower than those found in any other series. The proportion of adults with splenomegaly was also lower than that of other studies. Chest pains were more frequent in males, while bone or joint pains and splenic sequestration crises seemed to be more common in females. Effects of the disease in the viability and fertility of these patients were quantified. Fetal loss in 67 pregnancies was 48%. Hemoglobin F levels showed a clear age effect, and higher levels were associated with a more benign course of the disease. Information about the services for prevention and treatment of sickle cell disease that exist in Brazil and one place in Venezuela, is provided. Treatment is only symptomatic in 12 centers, while in Sao Paulo piracetam is being successfully used in the treatment of crises. A brief overview about the current Brazilian studies on this disease is also presented.


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